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CHECK REQUEST FORM
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MARY WOODWARD PSO
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ATTACH ALL RECEIPTS/INVOICES. If request includes more than one (1) receipt/invoice per committee/classroom, please attach the Expense Report Form listing each receipt separately. Chairperson (if applicable) must sign/approve all reimbursements. In partnership with the State of Oregon's "Oregon Smart Snack Standard" for schools, the PSO does not reimburse for candy/treats. For convenient calculating, this form is available electronically on the PSO Website under Forms & Tools.
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NAME:DATE:
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NOTES:CHAIRPERSON:
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PAYEE INFORMATION:
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Please choose one payment type below:
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Mail check (Checks take up to 7 days to be received from the bank. Checks are sent from Chase Bank.)
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Zelle (Instant payment - Must be registered with Zelle. Provide mobile # or email connected to your account.)
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Check Payable To/ Zelle Registered Name:
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Mailing Address:
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Email:Mobile #:
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ITEMIZED BUDGET EXPENSES BY BUDGET CATEGORY (Summary of Expense Report, if needed):Amount:
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Committee/Classroom:
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Committee/Classroom:
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Committee/Classroom:
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Committee/Classroom:
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TOTAL (When used electronically, this cell automatically calculates above entries):
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Special Instructions/Committee Approval (Requests over $500):
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SIGNATURES:
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Chairperson (if applicable)/PSO Board Member Signature (Required)
Date
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PSO Board Member Signature (Required)
Date
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TO BE COMPLETED BY TREASURER:
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Date Paid:
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Check/Confirmation #:
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