Disbursements

Disbursement/Reimbursement Form

Fill in the following boxes and then click on "Submit"

Name:
Daytime Phone:
email:
Today's Date:

Purpose of Expense:
Committee:
Budget Category (if known):

Items and Amounts
Item 1:
Item 2:
Item 3:
Item 4:
Item 5:
Item 6:
Item 7:
Item 8:
Item 9:
Item 10:
Grand Total:

Make a check? Yes No
No, item was charged to our account. Bill is coming from:

Yes, make a check payable to:
Check Memo Text:
Should we mail the check?
No, do not mail. Place in church mailbox labeled:
Yes, please mail to name/address:

Are the funds from an approved budget category? Yes No
If yes, did the chair of this committee authorize it? Yes No
(or name of person who did authorize it )
If the funds are from outside the approved budget, then this was authorized by BOTH
Committee Chair: AND
Finance Officer or Treasurer:

PLEASE SUBMIT RECEIPTS (IF APPLICABLE) TO ADMINISTRATOR AS SOON AS POSSIBLE. Please include the date you submitted this form, to help us match the receipts with the request.

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