Check Request / Reimbursement Form

Need a check or reimbursement? This is your form.

Company
This field is for validation purposes and should be left unchanged.
Name*
First Last
Email*
Expense Details
Ministry Name (Fund)*
Please specify which ministry or fund this relates to. (For more than one—leave notes below). Note designated funds will always be used first (where applicable).
Expense Details*
Receipt Vendor Amount in Dollars What was this used for?
Total*
Copy of your Receipt/Invoice*
Drop files here or

Accepted file types: pdf, jpg, png, jpeg, gif, Max. file size: 30 MB, Max. files: 15.
Required for Reimbursement requests (Hint: You can take a picture of the receipt using your phone, or use the copy machine scanner to digitize your receipt)
Check Details
Mailing Address for Check*
Street Address City State ZIP Code

All checks are processed through bill-pay, and will be mailed to this address.
Questions or Other Details?
OPTIONAL—If needed.

Receipt Vendor	Amount in Dollars	What was this used for?

Expense Details