PAYMENT REQUESTS
Trustees of the Synod of the RPCNA - 7408 Penn Ave., Pittsburgh, PA 15208, 412-731-1177, rpcnacontroller@gmail.com
For Travel and Non-Travel Expense Reimbursements and Payment Requests
Payee Name
*
Address
Email
*
Start Date of Travel
*
/
Month
/
Day
Year
Or Enter the Date of Expense in both boxes
End Date of Travel
*
/
Month
/
Day
Year
Type of Travel or Expense
*
SELECT AN ITEM - Select "Other" for non-travel expenses
Board Meeting
Committee Meeting
Conference
Fraternal Delegate
Missions Board Travel
Missions Team member
OTHER - including non-travel reimbursements
Other
(PLEASE DO NOT USE THIS FORM FOR SYNOD MEETING TRAVEL REIMBURSEMENT)
Board
SELECT AN ITEM IF APPLICABLE
Benefits
Education+ Publications
Geneva Corporators
Global Missions
Home Missions
Seminary
Trustees of Synod
Committee
SELECT AN ITEM IF APPLICABLE
Business of Synod
CASA
Chaplain
Church History/Archives
EA Commission
Finance
Global Alliance
Graduate Study
Interchurch
Intl Conference
Vital Churches
Youth Ministries
Other Committee
Other
Mission Field
SELECT AN ITEM IF APPLICABLE
Cyprus
EA
India
Japan
Pakistan
South Sudan
Outside USA
# miles driven in 2024
miles driven in 2024 only
Mileage (@ $.67/mile)
IRS Mileage Rate
# of days for Per Diem, in lieu of parking, tolls, meals
Per Diem ($30/day)
Parking
(Only If Per Diem Is Not Used)
Tolls
(Only If Per Diem Is Not Used)
Meals
(Only If Per Diem Is Not Used)
Total Parking, Tolls, Meals
Airfare
Rental Car
Taxi / Uber
Any Other Expenses
All other non-travel expenses
Description of Any Other Expenses
Total Payment
Payment Method (Note: this is an encryted form)
Select Check or Electronic Funds Transfer
*
Check
EFT
Bank Routing # for EFT
9 digits without dashes
Bank Account # for EFT
Numbers only without dashes
Attach Required Receipts & Additional Information
Browse Files
Cancel
of
Please print form before selecting submit.
Submit
Print Form
Should be Empty: