LES PTO Electronic Disbursement / Reimbursement Request Form

Instructions:

Please fill out the Disbursement / Reimbursement Information completely and provide the breakdown of expenses.
For each expense, you can attach a file/picture/scan of each receipt, invoice, bid, or supporting documentation. (For disbursement requests, attach a copy of an invoice or bid. For reimbursement requests, attach a copy of a receipt.)
A receipt of your submitted request will be e-mailed to you (please keep for your records).
The treasurers will e-mail you when your check is ready to be picked up at the school or has been mailed to you.
ALL PURCHASES TAX-EXEMPT. Inform vendor that LES PTO is a tax-exempt organization. Tax-exempt forms are available HERE. The LES PTO DOES NOT reimburse sales tax.
Questions? Please e-mail our treasurer at lesptotreasurer@gmail.com.

Please remember: As a sales tax exempt organization, we cannot reimburse sales tax, so please give all vendors a copy of our sales tax exemption form to avoid being charged sales tax when you make your purchase.


Reimbursement Information
Requestor's Name Volunteer Title (if applicable) Email Address Cell Phone Make check payable to: Grand total amount for reimbursement: Would you like to pick up the check or have it mailed to your home (the address on your contact record)?* Mailing Address Please provide your mailing address if you would like check to be mailed Comments (AsNeeded)

Expense #1
Vendor Expense category* Amount Brief description of items purchased Attach receipt

Expense #2
Vendor Expense category Amount Brief description of items purchased Attach receipt

Expense #3
Vendor Expense category Amount Brief description of items purchased Attach receipt

Expense #4
Vendor Expense category Amount Brief description of items purchased Attach receipt

Expense #5
Vendor Expense category Amount Brief description of items purchased Attach receipt