Expense Reimbursement or Payment Request Please enable JavaScript in your browser to complete this form.Requested by:Type of RequestRequest for reimbursement for church-related expensesRequest for a refundRequest for a payment to a third partyAre you the person who approves this expenditure?YesNoIf you are not the person who approves this expense please request approval, come back to this form, and attach documentation below.Make this check payable to:Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneNote on memo line of check (optional):Amount RequestedCharge to Ministry Area:Resource (Office, AV, Buildings and Grounds)Spiritual Life (Worship, Music)Faith Development (Family Ministry, Adult Education, Young Adults)Faith in Action (Social Justice)Community Life (Membership, Fundraising)Other/Not SureIf other, please provide additional information.Charge to budget or reserve fund?BudgetReservePurchase or Payment Request DetailsPlease provide any information that will assist us in charging this expense to the appropriate budget line or reserve fund. (Examples: building maintenance, professional expenses, guest speaker fee, office supplies).Upload the receipt for reimbursements here. Click or drag a file to this area to upload. Upload a copy of the receipt (document attachment or photo). Upload the approval of the expense here. Click or drag a file to this area to upload. Upload documentation of the approval (copy of email correspondence).If you have questions, please contact the Congregational Administrator at liberalfaith@ouuc.org. Checks are issued by OUUC’s bill paying service. The return address is not OUUC’s address.Submit
Olympia
Olympia