Disbursement Request Form

Instructions:

Please fill out completely with description/reason for payment or reimbursement plus a breakdown of expenses.
Attach up to 3 files/pictures/scans of all receipts and supporting documentation.
A receipt of your submitted request will be e-mailed to you (please keep for your records).
The treasurer will e-mail you when your check is ready.
Questions? Please e-mail treasurer@bearcreekpta.org

As always, 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.

Type of Disbursement (reset)

Payment Redemption Reimbursement

Payee/Vendor Name

How should the vendor/payee be paid?

Total Amount Requested for Reimbursement/Payment:

Please do not include sales tax as it cannot be reimbursed. A copy of our organization's Tax Exempt Form is available on the Shared Drive to be provided to vendors.

Committee/Event

Description/Purpose:

Attach Receipt/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Date Payment Needed By:

Comments

Please enter any questions or additional information that may be needed.

NOTE: This form must be submitted at least 10 days prior to payment request or within 30 days of a completed purchase. Once received, please allow 5 business days for processing.