Hill PTA Reimbursement and Check Request Form

Online Submission
Name*
First Last
Email*
Enter Email Confirm Email
Phone*
Reimbursement Amount Total*
Today's Date*
MM slash DD slash YYYY
Date Check Needed
"Checks are issued weekly. If you have an urgent request, please add that in the notes. Otherwise expect your check within 7 days"
MM slash DD slash YYYY
Make Check Payable To*
"First and Last Name or Company Name"
Address (Check Delivered To)*
- Hill Elementary (all teacher reimbursements will be delivered to school weekly)
- Other Address (List Below)
Other Address (Check Payable To)*
Street Address Address Line 2 City State ZIP Code
Account to be debited*
If you don't know what account to charge, describe what the purchase is for
Itemized Requests
If your invoice reflects more than one account, please identify each and the amount that should be deducted from each. Remember to use the sales tax exemption certificate when purchasing items for PTA use. SALES TAX WILL NOT BE REIMBURSED
Item Place of Purchase Amount Total
Remarks
Attach receipt(s)
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.
Upon successful submission of this form, you will receive a confirmation message and an email. If you do not receive this, your form was not successfully submitted. Scroll up to see any error messages or omitted fields.
Contact treasurer@hillelementary.com if you have any questions.

Online Submission

Item	Place of Purchase	Amount	Total