Multi-Receipt Form

Receipt Form

Required for all purchases made with a PEX pre-paid credit card, store cash card, or other means of payment other than personal funds to be reimbursed.

Your Info
Your Info
Name*

First NameLast Name
Email*
yourname@ctk.church
Submitting For

SelfSomeone Else
Who are you submitting this for?

First NameLast Name

Receipt Info
Receipt Info

You can enter up to 10 receipts at a time. Please include all relevant details, in including an image or PDF copy of your receipts.
What kind of receipt(s) are you submitting?*

Ministry/OperationsBlessing
Are you submitting these receipts to reconcile a cash advance?*

YesNo

How many receipts would you like to submit?*
Are all receipts for the same department & budget?*

YesNo
Are any of your receipts associated with a Purchase Request?*

YesNo
Are all receipts on the same Purchase Request?*

YesNo
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Campus, Department, & Budget*
Receipt Info

Please include all relevant details, in including an image or PDF copy of your receipts.

Receipt #1 Info
Purchase Date*

MonthDayYear
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #1 Campus, Department, & Budget
Description of Purchase*
Vendor/Store Name*
Payment Type*
--Choose one--
Card Name*
Last 4 Digits of Card or Check #*
Purchase Total*
Blessing Account*
Card Used*
Upload Receipt #1*

Cancelof

Receipt #2 Info
Receipt #2 Campus, Department & Budget*
Purchase Date*

MonthDayYear
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Description of Purchase*
Vendor/Store Name*
Purchase Total*
Payment Type*
--Choose one--
Card Name*
Last 4 Digits of Card or Check #*
Blessing Account*
Card Used*
Upload Receipt #2*

Cancelof

Receipt #3 Info
Purchase Date*

MonthDayYear
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #3 Campus, Department & Budget*
Description of Purchase*
Vendor/Store Name*
Purchase Total*
Payment Type*
--Choose one--
Card Name*
Last 4 Digits of Card or Check #*
Blessing Account*
Card Used*
Upload Receipt #3*

Cancelof

Receipt #4 Info
Purchase Date*

MonthDayYear
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #4 Campus, Department & Budget*
Description of Purchase*
Vendor/Store Name*
Purchase Total*
Payment Type*
--Choose one--
Card Name*
Last 4 Digits of Card or Check #*
Blessing Account*
Card Used*
Upload Receipt #4*

Cancelof

Receipt #5 Info
Purchase Date*

MonthDayYear
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #5 Campus, Department & Budget*
Description of Purchase*
Vendor/Store Name*
Purchase Total*
Payment Type*
--Choose one--
Card Name*
Last 4 Digits of Card or Check #*
Blessing Account*
Card Used*
Upload Receipt #5*

Cancelof

Receipt #6 Info
Purchase Date*

MonthDayYear
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #6 Campus, Department & Budget*
Description of Purchase*
Vendor/Store Name*
Purchase Total*
Payment Type*
--Choose one--
Card Name*
Last 4 Digits of Card or Check #*
Blessing Account*
Card Used*
Upload Receipt #6*

Cancelof

Receipt #7 Info
Purchase Date*

MonthDayYear
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #7 Campus, Department & Budget*
Description of Purchase*
Vendor/Store Name*
Purchase Total*
Payment Type*
--Choose one--
Card Name*
Last 4 Digits of Card or Check #*
Blessing Account*
Card Used*
Upload Receipt #7*

Cancelof

Receipt #8 Info
Purchase Date*

MonthDayYear
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #8 Campus, Department & Budget*
Description of Purchase*
Vendor/Store Name*
Purchase Total*
Payment Type*
--Choose one--
Card Name*
Last 4 Digits of Card or Check #*
Blessing Account*
Card Used*
Upload Receipt #8*

Cancelof

Receipt #9 Info
Purchase Date*

MonthDayYear
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #9 Campus, Department & Budget*
Description of Purchase*
Vendor/Store Name*
Purchase Total*
Payment Type*
--Choose one--
Card Name*
Last 4 Digits of Card or Check #*
Blessing Account*
Card Used*
Upload Receipt #9*

Cancelof

Receipt #10 Info
Purchase Date*

MonthDayYear
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #10 Campus, Department & Budget*
Description of Purchase*
Vendor/Store Name*
Purchase Total*
Payment Type*
--Choose one--
Card Name*
Last 4 Digits of Card Number or Check Number*
Blessing Account*
Card Used*
Upload Receipt #10*

Cancelof

Receipt Upload
Upload All Receipts

Please attach up to ten receipts associated with this submission.
Cancelof

Review Submission
Please review your submission for errors & ensure all files are attached before submitting.
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