Payment Request Form
For Payments and Reimbursements
This is a request for (check one)
Person requesting reimbursement/payment (must be auxiliary president or program/committee chair):
FYI: Your reimbursement or request for payment must be approved by the Pastor. Failure to do so may result in your payment request being questioned or denied.
Pay to the Order Of
Reason for payment/refund
Amount of purchase/refund
The complete address is required to ensure the accuracy of church records, as well as making sure that the check is mailed to the correct address.
File Upload (to attach your receipt, invoice, or supporting documentation to your voucher):