Expense Reimbursement Request Form

Date

Auxillary Department

Requested by

Description of Need/Activity

Make check payable to

Please give name of company, organization or persons to be paid. Provide address if check is to be mailed.

Request amount: $

Pastor’s Signature

Approved Disapproved

Finance Department Authorization

NOTE: Pastor’s Signature is required prior to presenting to finance office for reimbursements. Pleas attach all receipts.

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