Payment Request Form
Please use this form to request payment for an approved expense.
Requestor Info
Your name
*
First Name
Last Name
Your Email
*
Ministry/Department
Payee info
Name
*
Name of person or business to be paid
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Amount (in Dollars)
*
Any payments over $500 must have Expense Request approval attached
Payment Type
*
Please Select
Check
Credit Card
Electronic (ACH/Draft)
Paypal
Other
Please specify payment form
if applicable, paste the payment link here
Additional Instructions / Comments
File Upload
Browse Files
Drag and drop files here
Choose a file
Please upload an invoice and approval form (if over $500)
Cancel
of
Submit
Should be Empty: