Payment Request Form

For Invoices or Reimbursements

First Name *

Last Name *

Is this a reimbursement or an invoice? *

A reimbursement pays someone back for money spent out of pocket. Anything else is an invoice.

Expense Category / Ministry *

Reimbursement Details

How many transactions are covered? (1-7) *

Total Amount Requested

Invoice Details

Date of Services/Delivery *

What service/item was provided? *

What is the total cost? ($) *

Payee Details

Check Payable To (First Name) *

Last Name *

Submit for Confirmation

All congregant payments are subject to ministry leader confirmation or board approval. By clicking submit, an email will be sent requesting confirmation before payment is remitted.