Credit Card Charges

* Indicates required field

Date Charged *

Person Charging *

Credit Card Charged *

Vendor *

Account Number *

Amount of Charge *

Explanation of Charge *

Each credit card charge must be accompanied by a separate form. Receipts must be uploaded. If unavailable for a phone purchase a detailed description of the charge must be provided. For internet purchases, please upload any type of screenshot/digital file provided by the site. The form shall be signed by the Financial Secretary before purchases are made to verify the availability of funds. No personal charges are allowed; no exceptions

Name of Requestor *

Name of Financial Secretary *

Name of Pastor Signing *

First

Last

Scan of Paper Form A * *

Max file size: 20MB

This is the scanned copy of Form A. (The Pink Form)

Receipt(s) *

Max file size: 20MB

This is a scanned copy of the paper receipts or digital files produced by online purchases.

Additional Receipts *

Max file size: 20MB

Other attachments *

Max file size: 20MB

Other attachments *

Max file size: 20MB

Submit