MIRAMONTE HIGH SCHOOL BOOSTERS CLUB

MIRAMONTE HIGH SCHOOL BOOSTERS CLUB REQUEST FOR PAYMENT OF EXPENSES Requested by:

Name: _______________________________________________________ Position: _____________________________________________________ Phone: ______________________________________________________ Signature: ____________________________________________________

Date:

Requested: ________________ Check needed by:____________________

Payable to:

Name: _______________________________________________________ Address: _____________________________________________________ _____________________________________________________

Description of Expense: ____________________________________________________________ Sport to be charged: ___________________________ Total amount requested: $______________ Coach Signature: ___________________________________________________________________ Athletic Director Signature: ___________________________________________________________ Please attach the appropriate invoice(s), purchase order(s), and/or receipts to support payment. A separate request form is required for each check requested. Send request for payment to:

Miramonte High School Boosters Club P.O. Box 1961 Orinda, CA 94563

***PLEASE ALLOW UP TO 2 WEEKS FOR PROCESSING***

FOR THE TREASURER’S USE ONLY:

Date Received: _____________

Date Paid: ___________

Check number: _________

Check amount: _____________

Posted to expense account: _________________________

Notes: ____________________________________________________________________________