Expense Reimbursement Form
Full Name
*
First Name
Last Name
E-mail
*
Your E-mail Address
Do you have a Ramp Church Credit Card?
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Yes
No
IMPORTANT
If you have a Ramp Church Credit Card, Reimbursements should not be submitted on this form - they MUST be submitted through Ramp. If you have any questions about this, email finance@urbanrefugechurch.org
Address (If this is the first time you have requested a reimbursement, or you have a new address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Expenses List
Purchase Date
Vendor
Items Purchased
Ministry
Purpose
Cost
1
2
3
4
5
6
Do you need to request a mileage reimbursement
Yes
No
Mileage Reimbursement Log
Date of Travel
Time of Travel
Total Miles Driven
Ministry
1
2
3
4
5
6
Mileage Reimbursement
Expense Reimbursement
Total Reimbursement
Attach your itemized Receipt(s)
*
Browse Files
Receipts must have a date, include the total for everything on the receipt, and include the method of payment. If you are submitting a Target or Amazon receipt for more than 1-2 items, please submit an itemized receipt that includes everything in a single file list (including tax, if charged). If you have questions, please email finance@urbanrefugechurch.org. Thank you!
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*
I certify that all information entered above is valid and true.
Signature
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