Reimbursement and Check Request Form

For reimbursement, please submit this form within 30 days. Please ensure you have uploaded your receipts.

PLEASE SUBMIT ONE FORM PER EVENT! Do not include multiple events on one form.

Please attach receipts or invoices for the total amount of reimbursement or check request.

Submit to Assistant Treasurer within 30 days of the event.

Illinois State and Local Tax are not reimbursed. Please use PTO tax exemption.
Reimbursement should happen within 1 week of submitting receipts and form.
Direct questions to the Assistant Treasurer, Nicole Corbiere at assistant@thelaneschoolpto.org

Name Email

Reimbursement Details
Committee/Event Expense Description Date Needed Required only if reimbursement is needed by a certain date

Payment Information
Reimbursement Amount Reimbursement Method (reset) Zelle Check/Bill Pay

Payment Details
Enter payment details below If you chose a Zelle reimbursement, please enter the email or phone number associated with your Zelle Account. If you chose to receive a physical check or online bill pay, please enter the name the check should be made out to and the mailing address it should be sent to.

Receipts
We cannot process payment without appropriate documentation. Attach Receipt/invoice #1 Attach Receipt/Invoice #2 Attach Receipt/Invoice #3 Attach Receipt/Invoice #5 Attach Receipt/Invoice #5 Attach Receipt/Invoice #6 Attach Receipt/Invoice #7

Notes to the Treasurer
Please add any notes for treasurer