Date *
Name *
Amount You Are Seeking
Describe the item for which you are seeking reimbursement. If you know the budget category, you may add that in; otherwise, the office will supply it when it is approved and forwarded to the Treasurer. If this payment goes to someone other than yourself, please include that name and address in this message box.
Please be sure to submit the receipts or scan copies of the receipts to accompany this request. This may be done in the church office. These must be submitted for auditing purposes. If you scan at home, please send copies to