Reimbursement Request - Briar Glen PTC

If you prefer to download a physical form to fill out, click the button below. You’ll then need to get this form to Briar Glen. Please note: This is not an editable PDF.

Download reimbursement form

For a quicker response, submit the reimbursement form below. Eric Sedlak, the Briar Glen PTC Treasurer, will receive your request and will begin the process.

"*" indicates required fields

Your contact information

Your name*

First Last

Your phone number*

Your email address*

Expense details

Project / Category for this reimbursement*

Detailed description of this expense*

This reimbursement is for:*

An out of pocket expense

A check request to pay invoice

Reimbursement details

Check payable to:*

First name Last name

Amount*

Full address*

A check will be mailed to this address.

Street Address Address Line 2 City State ZIP Code

Receipt(s) totaling the amount of reimbursement or an invoice for check request must be attached. Sales tax will not be reimbursed, so please be diligent in using the Tax Exempt Status letter when purchasing items for the PTC.

Upload your receipt(s) and/or invoice(s)*

You are allowed to upload jpg, gif, png, and pdf files only.

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.

Your contact information

Expense details

Reimbursement details

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