Check Request Form

Instructions:

Reimbursements can be made via check or Zelle. Please attach receipts for this expenditure. Note: Long Hill Township PTO is a tax exempt organization. When purchasing items on behalf of the PTO, please remember to show a copy of the PTO's tax exempt certificate to avoid paying sales tax. Copies of the tax certificate are available from the treasurer.

Email any questions to lhtptotreasurer@gmail.com

A receipt of your submitted request will be emailed to you (keep for your records)

Reimbursement Information

Check Payable To:

Total Amount Requested:

Mailing address:

Account holder name and email or cell phone number for reimbursement via Zelle: **To receive a Zelle payment, you must be registered for Zelle through your bank**

Date check is required by vendor, if treasurer is paying the vendor directly:

Expenses for Reimbursement

Reason for Disbursement

Expense Is For:

Place of Purchase - Receipt #1

Amount of purchase - Receipt #1

Attach Receipt #1