Asbury United Methodist Church
4257 Keameysville Pike + Shepherdstown, WV + 25443
Phone: 304-876-3112 +Fax: 304-876-3056 + Email: info@asburyshep.org
Pastor: Rev. Dr. Derek Shackelford
Purchase Requisition, Reimbursement & Credit Card Use Form
Date:
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Month
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Day
Year
Date
Church Administrator's Initials:
Request made by:
Organization/Program/Ministry:
***Please choose from Accounts on back of this form
Rows
Account
Amount
Description
1
2
3
Required date for funds:
Check one:
Reimbursement/Payment Check Made out to:
Address where Check is to be sent:
Please attach invoice or receipt of items purchased to the back of this sheet.
Credit Card or Business Charge Purchase
If Business Charge---Business Name:
Business Name:
Business Manager's Signature:
Date:
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Month
-
Day
Year
Date
Pastor's Signature:
Date:
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Month
-
Day
Year
Date
Preview PDF
Submit
Should be Empty: