Washington High School PTA

$$$$$ Request for Expense Reimbursement $$$$$

ATTACH RECEIPTS

SPECIFY COMMITTEE / BUDGET LINE ITEM

Date Requested:          

Requested by:                  

Expense Amount:       

Committee/Budget Line Item:                     (if possible)

Make check payable to:   Name                ____________

                                       Address            ____________ 

                                                          Phone ____________

Expense Details (attach receipts):

------------------------------- Treasurer use only ----------------------------

Date issued: