PBL ATHLETIC BOOSTER CLUB

Request for Funds/Donation

Explanation of Request: (Give a brief description of the request and the sport for which the funds or donation(s) are being requested.)

Justification: (Explain why these funds or donation(s) are being requested.)

Date of Need for this Item:

Availability of Item (In-Stock or Special Order):

Name of Vendor Item Will Be Purchased From:

Amount of Funds Requested:

(Include Shipping, Handling and All Other Associated Costs)

Signature of Requestor Date

Requestor’s Position

Signature of Athletic Director Date

Board Action: Approved Disapproved

Comments/Explanation: ____________________________________________

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Signature of Board Members:

Date of Decision: