Guy K Stump Elementary School PTA Withdrawal Request
Please attach all receipts or vendor invoices. Each receipt should be a separate line on the form. Please do not combine receipts on the same line!
No payment will be made without a valid receipt, contract or invoice.
Teacher/Staff Reimbursement Requests - you verify by signing this form that these items in your reimbursement request will directly benefit
the students in your classroom during the current school year. Please explain use briefly in the Expense Reason box.
All ACH/Debit transactions MUST have a receipt attached and will be sent for verification with a second signature.
Email
Treasurer@StumpPTA.com
with any questions!
Requestor Information
Name
*
Date
*
/
Month
/
Day
Year
Date
Phone
*
-
Area Code
Phone Number
Email
*
example@example.com
Reimbursement Type
*
Reimbursement
Pay Invoice
ACH Transaction
Debit Card Transaction
Cash on Hand Request
Refund
Reimbursement Receipts
Receipts for Reimbursement
Vendor
Amount
Expense Reason
Receipt 1
Receipt 2
Receipt 3
Receipt 4
Receipt 5
Receipt 6
Receipt 7
Receipt 8
Receipt 9
Receipt 10
Receipt 11
Receipt 12
Receipt 13
Receipt 14
Receipt 15
Total from Back
Receipt Total
Invoice Payment Request
Vendor
Amount
Expense Reason
Vendor Address
Check Delivery Instructions
Date Check Needed
/
Month
/
Day
Year
Date
ACH/Debit Card Transaction
Vendor
Amount
Expense Reason
Purchaser
Purchaser Signature
Name of Person to Verify Purchase
Email of Person to Verify Purchase
example@example.com
Verified By Signature
Cash on Hand Request
Event Cash is Needed For
Amount
Refund
Vendor or Processor
Amount
Explanation of Refund
Requestor Signature
All supporting receipts and documentation must be uploaded with your submission. If you are a staff member and are combining your grant request money with anyone you must also upload a signed letter stating the details of the combination of grants.
Browse Files
Cancel
of
Preview PDF
Submit Request
PTA Treasurer Use Only
Check Number
Check Date
/
Month
/
Day
Year
Date
Check Amount
Budget Category
Treasurer Notes
Should be Empty: