Reimbursement & Check Request

Who should the check be addressed to?

Where should the check be sent? If you do not want it mailed but will collect it from the office, leave blank or write "Pick Up from Office."

E.g., Harris Teeter, Costco, TJ's Deli, Amazon, etc.

Date

E.g., Life Groups, Women's Ministry, Nursery, etc. If you don't know the correct category, please explain what the expense is for.

Add all receipts and enter the total amount here.

Please attach all receipts

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