Reimbursement Form

Reimbursement Form- Year 2025

Fill out one reimbursement form per individual and one reimbursement form per purpose. Receipts MUST be uploaded for reimbursement approval.
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Today's Date*

MonthDayYear
Name of Applicant*

First NameLast Name
Check Payable To*
Email*
example@example.com
Phone
Please fill in if you are requesting a procurement for the first time.
Mailing Address
Please fill in if you are requesting a reimbursement for the first time or have recently moved.
Purchase Details

List only purchases relevant for the same purpose. For item reimbursement of a different purpose, fill out a separate reimbursement form.
Date(s) of Purchase*

MonthDayYear
Date
Purchase Request #

For next question：
- Select "DH" if you are the department head.
- Select "RP" if this is a recurring purchase that has been approved for the current year. If you know the original purchase request form # that shows the recurring purchase approval in current year, please provide it to speed up the process.
- Otherwise, please select "None of above" and the purchase requesst form # is required. Check your email for your original purchase request form # after your request was approved by the department head. REIMBURSEMENT WILL NOT BE MADE UNLESS PURCHASE REQUEST HAS BEEN FILED AND APPROVED:
Purchase Request Form
ERROR! You are NOT the Department Head of the department you selected, so you can not select "DH“. Please correct your answer.*
Please select*

I am Department Head (DH)This is an approved recurring purchase of the current year (RP)None of above
Purchase Request #
Purpose of Purchase*
Location of Purchase & Description of Items Purchased (ex: Smart & Final- cups, spoons, plates)*
Payment Type*

CashCheckPersonal credit cardChurch credit card
Total Amount To Be Reimbursed*
Department*

AdministrationCatalyst School of MinistryMinistry - Adult (English)Ministry - CoffeeMinistry - Feast College (English)Ministry - Flint Jr. High (English)Ministry - Harvest Bible University (HBU)Ministry - Lifeline High School (English)Ministry - Media ProductionMinistry - Prayer (Chinese)Ministry - Prayer (English)Ministry - Small Groups (English)Ministry - Vineyard KidsMinistry - VOH ChoirMinistry - WorshipMinistry - Young Families (English)Ministry - Youth/College (Chinese)Missions/Social JusticePastoralTrafficOther
If Other is selected, please specify ministry*
Department data sheet to form*
Department Head*
Label Receipt & Upload
Receipt must be uploaded for approval. Multiple receipts can be selected at once.

Please label all uploaded files as Date_Name_Place either on the name of the file or physically on your receipt.
File Upload*

Cancelof
No receipts uploaded!
Type your name as your signature to declare that the receipt cannot be obtained from the supplier.

Reimbursement Form- Year 2025

Purchase Details