Reimbursement request

Instructions:

This form is to be used by Madison staff and PTO members to submit reimbursement for an approved expense.
Please fill out completely with description of reimbursement and breakdown of expenses.
Attach a file/picture/scan of each receipt or supporting documentation.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
Checks for staff will be dropped off in the main office once processed.
Checks for vendors will be mailed AND you will be notified when that happens.
Questions? Please e-mail our treasurer at treasurer@madison-pto.org


Your Information
Enter your Name Your e-mail address Staff, please use your @ahschools.us address. Type Type of reimbursement. Notes Please enter any notes or extra information the treasurer should know about your request. Make check payable to: Grand total amount for reimbursement:

Vendor 1 (Optional)
Vendor Name Amount Brief description of items purchased Attach receipt / invoice

Vendor 2 (Optional)
Vendor Name Amount Brief description of items purchased Attach receipt / invoice

Vendor 3 (Optional)
Vendor Amount Brief description of items purchased Attach receipt / invoice

Signature
Signature Please type your full name to sign this request. You are attesting that the information above is a true expense and the funds were utilized to support Madison elementary students and/or staff.