Request for Saxe PTC Funds (Reimbursement of Approved Expenses)

Instructions:

Please fill this form out completely and attach one file with copies of all receipts (preferably a PDF).
Please circle the items that you are being reimbursed for if there are additional items listed on the receipt.
If you are unable to attach a file to this form, please email a copy or picture of the receipt(s) to Laura Sousa at laura.derossi@gmail.com. We will not be able to send the reimbursement until we receive the receipt(s).
IMPORTANT: Saxe PTC is a tax-exempt organization and is therefore unable to reimburse sales tax.

If you have any questions, please contact PTC Treasurer, Laura Sousa, at laura.derossi@gmail.com.

Reimbursement Information

Your Name:

Your Address:

Your Telephone Number:

Your Email Address:

Check Payable To:

Total Amount For Reimbursement (excluding sales tax):

Team, Committee or Activity:

Description of Purchase:

Attach Receipts:

Please attach one file with copies of all receipts