Expense Report Form

Complete and submit the form for expense reimbursement incurred on behalf of our church or a group/committee.

Contact Information

Submitter’s Full Name: *

Phone *

Email *

Project/purpose: *

Charge to (Committee, etc.): *

Make check payable to: *

Reimbursement check Delivery Options: *

Address

Expense Details & Total

Expense Total Requested: *

1. Date of Purchase *

1. Description of Item(s) *

1. Vendor *

1. Amount *

1. Receipt? *

2. Date of Purchase

2. Description of Item(s)

2. Vendor

2. Amount

2. Receipt?

3. Date of Purchase

3. Description of Item(s)

3. Vendor

3. Amount

3. Receipt?

4. Date of Purchase

4. Description of Item(s)

4. Vendor

4. Amount

4. Receipt?

5. Date of Purchase

5. Description of Item(s)

5. Vendor

5. Amount

5. Receipt?

Upload Receipts

Receipt 1

Click or drag a file to this area to upload.

Choose File

Receipt 2

Click or drag a file to this area to upload.

Choose File

Receipt 3

Click or drag a file to this area to upload.

Choose File

Memo:

Submitter’s Signature *

Date *

Approval Signature

Date

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Expense Report Form