Check / Credit Card Request (Mar 2023+)

Check / Credit Card Request
Form Designer: If this link ever changes, please update the "Benevolence Assistance Log" Jotform as well
Request Type*

Check RequestCredit Card Request
Check Req. #
Credit Card Req. #
What is the justification for NOT submitting a Check Request?*
Your Name*
Your Email*
example@example.com
Click HERE for the 2024 Budget
Check 1-2 boxes that apply: This expense...*

Is PLANNED and falls WITHIN the approved budget line itemOccurs ON TARGET per the approved budget timeframeIs PLANNED but EXCEEDS the approved budget line itemOccurs BEFORE the approved budget timeframeIs UNEXPECTEDOccurs AFTER the approved budget timeframeIs an Administration or Operational expense

CHECK PAYMENT DETAILS
Payee*
Have an invoice or receipt? Be sure to attach it to the form.
Mail or Pickup Check?*

MailPickup
Show Additional Check Request Field(s):*

Attn:Quote/Invoice (upload quote/invoice)Reimbursement (upload receipt)Tax IDNone of the above
Upload Receipt(s)

Upload a File

Cancelof
Upload Quote/Invoice

Upload a File

Cancelof
Benevolence Applicant
Account Number
For benevolence
Benevolence Team Member
Attn:
Mailing Address

Address

Address 2

CityState

Zip
Tax ID

ITEM REQUEST(S)
IMPORTANT REMINDER:

Please ensure that NO SALES TAXES were incurred since we are a 501(c)(3) organization. If you need a tax exempt form, please download HERE or contact the church office.
I have multiple items
Item 1*
Quantity*
Unit Price*
Total*
Item 2
Quantity
Unit Price
Total
Item 3
Quantity
Unit Price
Total
Item 4
Quantity
Unit Price
Total
Item 5
Quantity
Unit Price
Total
Item 6
Quantity
Unit Price
Total
Item 7
Quantity
Unit Price
Total
Item 8
Quantity
Unit Price
Total
Item 9
Quantity
Unit Price
Total
Item 10
Quantity
Unit Price
Total
Grand Total
Comments
Should be Empty:

Check / Credit Card Request