Expense Voucher Request

Expense Voucher Request

Thank you for your service to the Church & the Synod of South Atlantic!
Please complete this form to be reimbursed for the cost of travel to/from synod meetings or related events. You can read the synod's Travel Policy HERE.
Requested by*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Reimbursement Schedule

Meals: Max combined meal reimbursement	$50
Breakfast	$10
Lunch	$14
Dinner	$26

Reimbursable Expenses (attach receipts)*

	Date (MM/DD/YY)	Expense	Meeting Code	Amount for Reimbursement
1
2
3
4
5

Total Reimbursable Charges

Mileage Payable

	Date (MM/DD/YY)	Meeting Code	# Miles	.35/mile
1
2
3

Total Mileage Reimbursement
Total Amount for Expense Requested
Take a Photo of Your Receipt
Upload Receipt File

Browse Files
Best for electronic receipts Cancelof
I wish to:*

be reimbursed in full for these expenses.donate these expenses as a contribution to the synod. Please send a written acknowledgement of this amount
Date*

MonthDayYear
Date
Signature*

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