All requests must be supported by original receipts or invoices. After submitting this form, please email photos of the supporting receipts/invoices (in one email) to PTC Treasurer, Nicole Lowry (treasurer@cedarparkptc.org). Checks will be mailed to the address below after receiving this form and the supporting receipts/invoices.

Check Payable To:

Amount

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Committee/Event

Brief Explanation of Expense/Receipt

Person Submitting Request

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

By requesting this reimbursement, I certify that:

ALL SUBMITTED EXPENSES ARE PTC-RELATED, ACCURATE, AND COMPLY WITH THE CPMS PTC REIMBURSEMENT POLICIES.
I HAVE NOT RECEIVED, NOR WILL I RECEIVE, REIMBURSEMENT FROM ANY OTHER SOURCE(S) FOR THE EXPENSES CLAIMED.
IN THE EVENT OF OVERPAYMENT, I ASSUME RESPONSIBILITY FOR REPAYING THE CPMS PTC IN FULL FOR THOSE EXPENSES.