PAYMENT REQUESTS

PAYMENT REQUESTS

Trustees of the Synod of the RPCNA 7408 Penn Ave, Pittsburgh, PA 15208 412-731-1177 controller@rpcna.org
2026 Expense Reimbursements and Payment Requests

For Travel and Non-Travel for Boards and Synod Committees (not for the annual Synod meeting)
Payee Name*
Address
Email*
Date of Expense or End Date of Travel*

MonthDayYear
Type of Expense*
Other Information
(PLEASE DO NOT USE THIS FORM FOR SYNOD MEETING TRAVEL REIMBURSEMENT)
Board
or Committee of Synod
Other Information
Mission Field
Other Countries
Mileage:
Miles driven
for 2026 only
Mileage
IRS Mileage Rate: $.725/mile
Per Diem (in lieu of parking, tolls, meals):
Days for per diem
Per Diem
$40/day
Actual parking, tolls, meals (in lieu of per diem):
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
Other Travel:
Airfare
Rental Car
Taxi / Uber
Other Expenses:
All Other Expenses
All other travel or non-travel expenses
Description of All Other Expenses
Total Payment Request:
Payment Method (Note: this is an encryted form)

Note: It is only necessary to update your bank routing and account numbers if you have not previously submitted a reimbursement request on this form or if your bank account information has changed since your last request.
Select Check or Electronic Funds Transfer*

CheckEFT
Bank Routing # for EFT
9 digits without dashes
Bank Account # for EFT
Numbers only without dashes
Attach Required Receipts & Additional Information

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PAYMENT REQUESTS

2026 Expense Reimbursements and Payment Requests

Mileage:

Per Diem (in lieu of parking, tolls, meals):

Actual parking, tolls, meals (in lieu of per diem):

Other Travel:

Other Expenses: