Reimbursement Form

Please fill out this form carefully, click Submit

Reimbursement Form

Name

*

Phone

*

Email

*

This address will receive a confirmation email

Date of Expense

*

Purpose of the Expense

*

Amount

*

Budget Line #

*

Please select one option.

1-5-103 Guest Ministers 1-5-183 DLRE Professional Expenses 1-5-252 Grounds and Parking Lot 1-5-520 Church School 1-5-530 Child Care 1-5-540 Adult RE 1-5-560 Youth 1-5-570 Background Checks 1-5-620 Worship Decorations 1-5-860 Memorial Services Reception Multiple or Other - please describe below

Upload Receipts / Invoices When Appropriate

Upload (8MB)

Upload additional if required

Upload (8MB)

Upload additional if required

Upload (8MB)

Preferred Payment Method:

*

Please select one option.

Check to be Mailed Direct Deposit Leave Check in Mail Box Not required - Church Credit Card Receipts

If check is to be mailed please specify name & address or same as claimantt

If direct deposit, please mention your bank routing & account no

If check to be left in mailbox, please specify whose mail box

Additional Comments, If any

Reimbursement Approved By

*

I certify that the expenses listed above are accurate to the best of my knowledge.

*

Please select all that apply.

I agree to the above.

Thank you for submitting the form. Make sure to upload any Receipts/Invoice if applicable.

Description

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