Charlton Heights PTA Check Request Form
Requester’s Name: ____________________________________  Date:  _______________________
Committee or Program: _____________________________________________________________
Amount:  $__________________________
Description of expenditure:  

Please attaché receipts and indicate items on receipt for reimbursement.  If paying a bill, please attach copy of invoice.  Do not include Sales Tax – we cannot pay Sales Tax.
Check payable to:  	_____________________________________________
Send check to:	  	______________________________________________
			______________________________________________  
Please indicate either your home address or your child’s mane and teacher including grade if you would like the check sent home to you through back pack mail.  If it is a bill that needs to be paid, please include any paperwork and the treasurer will mail it back to you.  Please leave this completed form in the treasurer’s mailbox in the office area at CHES.
Treasurer’s Use:  Check Number:  _____________________