Fill out the information below and attach the receipt to request reimbursement for church expenses. Name: Address: Email: Date of Purchase: Vendor Name (if not on receipt): Vendor Date (if not on receipt): Purpose of Expense: Amount: Expense Account Charged: Is this a reimbursement? YesNo What name do we make the check to? Is receipt lost? YesNo If yes, then I certify that the receipt was lost. In place of a signature, please type your name. Attach receipt: Δ
