Request for reimbursement

Your Name

Email address*

Purchase Reason*

Please identify the project that this purchase is related to.

Send check by mail?

Yes

No, I'll receive it at church

Address*

Number of items listing for reimbursement

Item 1

Vendor*

Item description*

Amount in dollars (inc. TAX)*

Item 2

Vendor*

Item description*

Amount in dollars (inc. TAX)*

Item 3

Vendor*

Item description*

Amount in dollars (inc. TAX)*

Item 4

Vendor*

Item description*

Amount in dollars (inc. TAX)*

Item 5

Vendor*

Item description*

Amount in dollars (inc. TAX)*

Item 6

Vendor*

Item description*

Amount in dollars (inc. TAX)*

Item 7

Vendor*

Item description*

Amount in dollars (inc. TAX)*

Item 8

Vendor*

Item description*

Amount in dollars (inc. TAX)*

Item 9

Vendor*

Item description*

Amount in dollars (inc. TAX)*

Item 10

Vendor*

Item description*

Amount in dollars (inc. TAX)*

Total cost in dollars

Upload all receipts

Are you human?*

Birmingham First Seventh-day Adventist Church

Birmingham First
Seventh-day Adventist Church

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

Item 8

Item 9

Item 10