2022/23 Debit Card Request Form

Request form for the use of the PTO Debit Card

Date*
MM slash DD slash YYYY
Name*
First Last
Email*
Phone*
The expense should be charged to this committee:*
Please describe the expense and special instructions for online ordering*
Anticipated Expense Amount*
The actual amount spent can not exceed the anticipated amount by 5%.
Please attach any support documents, especially for online orders
Drop files here or

Max. file size: 100 MB.
Treasurer Signature/Date

Please leave this blank. Treasurer must approve before PTO Debit Card may be charged.
President Signature/Date

Please leave this blank. President must sign to acknowledge that she/he used the debit card for the above expense.