Check Request/Reimbursement Request Form

Instructions:

Please fill out completely with description of reimbursement and 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).
Reimbursement can be mailed directly to you or provided electronically via Zelle.
Treasurer will email you when reimbursement has been sent.
Questions? Please e-mail our treasurer at dcmsptotreasurer@gmail.com

Check made payable to:

Should the check be mailed directly to you or placed in school mailbox or Zelle?

Total Amount Requested for Reimbursement/Payment:

Description/Purpose:

Attach Receipt/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Attach Receipt/Invoice #4

Attach Receipt/Invoice #5

Address

Please provide address to send check, if desired

Zelle payment details

Please enter Zelle name/number, if applicable