PTO Reimbursement Request Form

Instructions:

Please fill out completely with description of reimbursement and breakdown of expenses.
Attach up to 3 files/pictures/scans of all receipts and supporting documentation.
Questions? Please e-mail pto.stemlab@gmail.com

Your Name

How would you like to be reimbursed?

Check made payable to Whom? Email or Phone used for Zelle?

Total Amount Requested for Reimbursement/Payment:

For which team:

Description/Purpose:

Attach Receipt/Invoice #1

Attach Receipt/Invoice #2

Attach Receipt/Invoice #3

Thank you! Your reimbursement will be sent or delivered to your mailbox as soon as possible.