SERVING TOGETHER

Expense Reimbursement

Submit your request online to the church finance team.

Complete the details below and attach your receipts. Your approver will receive a private link to review and sign before treasury is notified.

Prefer a paper form? Download the reimbursement form (PDF) ↗

01Payee information

Fields marked * are required. If you are unsure of the expense coding, please ask your approver.

Payee name *

Payee email *

Expense coding / budget account *

Requested by *

Requester email *

Requester email language *

Payee mailing address *

City / State *

ZIP code *

02Purpose and payment method

Choose a check or ACH payment.

Purpose / brief description *

Payment method *

Bank name

Bank details below are required only when you choose ACH (enter bank details).

Bank account holder name

Routing number (9 digits)

Bank account number

03Expense details

Enter the date, description, and amount in USD for each expense. Add up to 20 expenses. The total is calculated automatically.

Expense 1: Date

Expense 1: Description

Expense 1: Amount (USD)

Expense 2: Date

Expense 2: Description

Expense 2: Amount (USD)

Expense 3: Date

Expense 3: Description

Expense 3: Amount (USD)

Expense 4: Date

Expense 4: Description

Expense 4: Amount (USD)

Expense 5: Date

Expense 5: Description

Expense 5: Amount (USD)

Expense 6: Date

Expense 6: Description

Expense 6: Amount (USD)

Expense 7: Date

Expense 7: Description

Expense 7: Amount (USD)

Expense 8: Date

Expense 8: Description

Expense 8: Amount (USD)

Expense 9: Date

Expense 9: Description

Expense 9: Amount (USD)

Expense 10: Date

Expense 10: Description

Expense 10: Amount (USD)

Expense 11: Date

Expense 11: Description

Expense 11: Amount (USD)

Expense 12: Date

Expense 12: Description

Expense 12: Amount (USD)

Expense 13: Date

Expense 13: Description

Expense 13: Amount (USD)

Expense 14: Date

Expense 14: Description

Expense 14: Amount (USD)

Expense 15: Date

Expense 15: Description

Expense 15: Amount (USD)

Expense 16: Date

Expense 16: Description

Expense 16: Amount (USD)

Expense 17: Date

Expense 17: Description

Expense 17: Amount (USD)

Expense 18: Date

Expense 18: Description

Expense 18: Amount (USD)

Expense 19: Date

Expense 19: Description

Expense 19: Amount (USD)

Expense 20: Date

Expense 20: Description

Expense 20: Amount (USD)

Total (USD): $0.00

04Approval and supporting documents

Enter the approver email and upload your receipts. The approver will sign electronically before treasury is notified.

Approver name *

Approver email *

Approver email language *

Receipts *

PDF, JPG, or PNG; up to 8 files, no more than 8 MB total. Include all your receipts. If paying by ACH with a voided check, attach it here too.

05Declaration and signature

I confirm that the information and amounts in this request are accurate and that I have attached the relevant receipts. This is a payment request; payment is subject to review by the church finance team.

Signer full name *

Draw your electronic signature *

Sign below using your mouse, stylus, or finger. Keyboard: Space starts/stops a stroke; arrow keys move the pen.

The signing date and time (UTC) is recorded automatically. Your information is used to process this request.

Please review your details before submitting.