Request for
Payment or Reimbursement of Funds Form
VERDUGO
HILLS HIGH SCHOOL BOOSTER
Date Requested: _________________ Total Amount Requested: __________________
Requested by: ______________________________________________
Position of Person Requesting Check:___________________________
Budget Category:________________________________________________________________
______________________________________________________________________________
Description of Expense / Items purchased: _____________________________________________
______________________________________________________________________________
______________________________________________________________________________
Payee: ________________________________________________________________________
Address:_______________________________________________________________________
Phone:________________________________________________________________________
ORIGINAL BILLS AND/OR RECEIPTS MUST BE
ATTACHED!
Requestor: please leave space below blank
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Approved by:
_______________________________Date______________________
Financial Secretary
Date Paid: __________________ Check Number: ___________
Amount Paid: ________________ Budget Remaining: _________
Budget Account Number_____________
Updated
