Check/Purchase Request Form

Expense Itemization *

Item Description

Expense Category

Quantity

Amount

Preferred Payment Method if approved: *

Issue Check to vendor Online Order (Website & Itemized Cart Needed) Request P-Card (limit $350) Expense Reimbursement (to be submitted later)
Check Payable To (Vendor):
Vendor Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Vendor Phone Number

Area Code Phone Number
Online Order Website
Enter website address here (https:///www...)
Please provide any supporting documents (e.g. vendor quotes or additional information on what the funds will be used for) that will assist in the approval of this request below.
Upload file or photo #1
Upload file or photo #2
Upload file or photo #3
I certify

I certify that all information entered above is valid and true.
Signature

Clear
Review Status:
Review Comments
Optional notes related to approval or denial.
Reviewer Email
example@example.com
Approval Signature
Should be Empty:

Kingdom Church of Christ