PORT CLINTON MUSIC BOOSTER REIMBURSEMENTS FORM

Please attach a copy of your receipt(s)

 

COMMITTEE/ACTIVITY TO BE CHARGED_______________________ DATE__________

 

NAME________________________________________

 

PHONE NUMBER __________________________ E-MAIL ___________________________

 

ADDRESS (if check is to be mailed) _______________________________________________

           

                        _________________________________________________________________

 

ITEMS PURCHASED

DATE OF PURCHASE

AMOUNT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE MAKE THE CHECK OUT TO: ___________________________________________

 

Committee Chair/ Music Director approval ________________________________________

(Must be signed prior to reimbursement) 

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TREASURER:

 

Date__________________ Check Number __________________

 

_______ Mailed          ________ Hand Delivered