PTA CHECK REQUEST FORM
Check Payable
to: ______________________________________________________
Check Amount:
________________________________________________________
Requestor:
_____________________________________________________________
Date Check
Needed: ____________________________________________________
Will Check
be Picked Up at School? YES: ___________
NO: ____________
Address Check
Should be Mailed to: _____________________________________
Purpose of
Check: ______________________________________________________
_______________________________________________________________________
PTA USE ONLY
Item in Budget? YES: _________________ NO: __________________
Authorized
by: _________________________________________________________
Check Number:
________________________________________________________
Date Paid:
_____________________________________________________________
PLEASE ATTACH ALL RECEIPTS!
Yamini Mitter
PTA Treasurer
(408)528-8325