PVA Disbursement/Reimbursement Check Request Form — Annunciation Day School

Parent Volunteer Association (PVA)

Disbursement/Reimbursement Check Request Form

Note:

Reimbursement requests should be submitted within 30 days of close of an event.
Original itemized receipt(s) or the packaging slip & invoice must be attached.
Receipts must be for the current school year.

Submission Options:

Fill out form below and scan receipts to Maria Hadjisimos.
Email completed form plus scan receipts to Maria Hadjisimos.
Drop off completed forms at school office with receipts.
Mail competed form & Original receipts to Maria Hadjisimos, PVA Treasure. Please email Maria Hadjisimos for address.

Name

First Name

Last Name

Date Submitted

MM

DD

YYYY

Email

Phone

(###)

###

####

Pay to the order of

Please send check to

provide address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Amount of payment requested

$

If you have any questions or need to request a rush check please email Maria Hadjisimos.