Midtown Check Expense Form 4.0 (Current)

MIDTOWN EXPENSE FORM
Is this a:*

request for a check to a vendorreimbursement request for yourself or volunteer (receipt required)
BEFORE CONTINUING, PLEASE READ BELOW!!

*Please submit separate check requests if you are submitting requests for two different churches (i.e. one reimbursement is for Downtown and one is for Lexington).
SECTION I - TO BE COMPLETED BY REQUESTOR
Your Name:*

First NameLast Name
Your Email Address:*
E-mail to be notified when check is ready (if different):
SECTION II - MAKE CHECK PAYABLE TO
MAKE CHECK PAYABLE TO:*
MEMO:
SELECT ONE:*

To be mailed (complete address below)To be picked up from office in checks pickup mailbox
ATTN:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Purpose for Funds*
What church is this for?:*

Central (City-Wide)DowntownTwo NotchLexington
To see approved budgets click here (will open in new window).
Central or Downtown budget owner who authorizes expense?*
Two Notch budget owner who authorizes expense?*
Lexington budget owner who authorizes expense?*
Grassroots Network budget owner who authorizes expense?*
Acct #'s for Budget Owner - Wes Butler:*
Acct #'s for Budget Owner - Allen Tipping (Grassroots):*
Acct #'s for Budget Owner - Chris Kakaras*
Acct #'s for Budget Owner - Adam Gibson:*
Acct #'s for Budget Owner - Alice McMahan/Jon Ludovina:*
Acct #'s for Budget Owner - Jake Blair:*
Acct #'s for Budget Owner - Michelle Jahnke:*
Acct #'s for Budget Owner - Ryan Shults:*
Acct #'s for Budget Owner - Jeremy Wilson:*
Acct #'s for Budget Owner - Jay Hendricks:*
Acct #'s for Budget Owner - Jon Ludovina:*
Acct #'s for Budget Owner - Megan Rife:*
Acct #'s for Budget Owner - Andrew Flowers:*
Acct #'s for Budget Owner - Brandon Clements:*
Acct #'s for Budget Owner - Hannah Disbrow:*
Acct #'s for Budget Owner - Kirsten Ellison:*
Acct #'s for Budget Owner - Michael Bailey:*
Acct #'s for Budget Owner - Taylor Schombert:*
Acct #'s for Budget Owner - Tiffany Coker:*
Acct #'s for Budget Owner - Ant Frederick:*
Acct #'s for Budget Owner - Catherine Failoni:*
Acct #'s for Budget Owner - John Nobles:*
Acct #'s for Budget Owner - Tremon Davis:*
*If you do not have permission to spend from a budget owner, please contact the necessary budget owner for approval.
Enter the appropriate Residency fund account:*
Enter the appropriate 2000 account:*
Amount:*
Upload additional file if necessary

Upload a File

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SECTION III - SUBMIT RECEIPTS
# of Receipts Submitting*
Transaction #1
What church is this for?:*

Central (City-Wide)DowntownTwo NotchLexington
Central or Downtown budget owner who authorizes expense?*
Two Notch budget owner who authorizes expense?*
Lexington budget owner who authorizes expense?*
Grassroots Network budget owner who authorizes expense?*
To see approved budgets click here (will open in new window).
Acct #'s for Budget Owner - Wes Butler:*
Acct #'s for Budget Owner - Allen Tipping (Grassroots):*
Acct #'s for Budget Owner - Chris Kakaras*
Acct #'s for Budget Owner - Adam Gibson:*
Acct #'s for Budget Owner - Alice McMahan/Jon Ludovina:*
Acct #'s for Budget Owner - Jake Blair:*
Acct #'s for Budget Owner - Michelle Jahnke:*
Acct #'s for Budget Owner - Ryan Shults:*
Acct #'s for Budget Owner - Jeremy Wilson:*
Acct #'s for Budget Owner - Jay Hendricks:*
Acct #'s for Budget Owner - Jon Ludovina:*
Acct #'s for Budget Owner - Megan Rife:*
Acct #'s for Budget Owner - Andrew Flowers:*
Acct #'s for Budget Owner - Brandon Clements:*
Acct #'s for Budget Owner - Kirsten Ellison:*
Acct #'s for Budget Owner - Hannah Disbrow:*
Acct #'s for Budget Owner - Michael Bailey:*
Acct #'s for Budget Owner - Taylor Schombert:*
Acct #'s for Budget Owner - Tiffany Coker:*
Acct #'s for Budget Owner - Ant Frederick:*
Acct #'s for Budget Owner - Catherine Failoni:*
Acct #'s for Budget Owner - John Nobles:*
Acct #'s for Budget Owner - Tremon Davis:*
Enter the appropriate Residency fund account:*
Enter the appropriate 2000 account:*
Transaction 1 Description*
Transaction 1 Amount:*
Upload all receipts, invoices, etc. for Transaction #1*

Upload a File

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Transaction #2
What church is this for?:*

Central (City-Wide)DowntownTwo NotchLexington
Central or Downtown budget owner who authorizes expense?*
Two Notch budget owner who authorizes expense?*
Lexington budget owner who authorizes expense?*
Grassroots Network budget owner who authorizes expense?*
To see approved budgets click here (will open in new window).
Acct #'s for Budget Owner - Wes Butler:*
Acct #'s for Budget Owner - Allen Tipping (Grassroots):*
Acct #'s for Budget Owner - Chris Kakaras*
Acct #'s for Budget Owner - Adam Gibson:*
Acct #'s for Budget Owner - Alice McMahan/Jon Ludovina:*
Acct #'s for Budget Owner - Jake Blair:*
Acct #'s for Budget Owner - Michelle Jahnke:*
Acct #'s for Budget Owner - Ryan Shults:*
Acct #'s for Budget Owner - Jeremy Wilson:*
Acct #'s for Budget Owner - Jay Hendricks:*
Acct #'s for Budget Owner - Jon Ludovina:*
Acct #'s for Budget Owner - Megan Rife:*
Acct #'s for Budget Owner - Andrew Flowers:*
Acct #'s for Budget Owner - Brandon Clements:*
Acct #'s for Budget Owner - Hannah Disbrow:*
Acct #'s for Budget Owner - Kirsten Ellison:*
Acct #'s for Budget Owner - Michael Bailey:*
Acct #'s for Budget Owner - Taylor Schombert:*
Acct #'s for Budget Owner - Tiffany Coker:*
Acct #'s for Budget Owner - Ant Frederick:*
Acct #'s for Budget Owner - Catherine Failoni:*
Acct #'s for Budget Owner - John Nobles:*
Acct #'s for Budget Owner - Tremon Davis:*
Enter the appropriate Residency fund account:*
Enter the appropriate 2000 account:*
Transaction 2 Description*
Transaction 2 Amount:*
Upload all receipts, invoices, etc. for Transaction #2*

Upload a File

Cancelof
Transaction #3
What church is this for?:*

Central (City-Wide)DowntownTwo NotchLexington
Central or Downtown budget owner who authorizes expense?*
Two Notch budget owner who authorizes expense?*
Lexington budget owner who authorizes expense?*
Grassroots Network budget owner who authorizes expense?*
To see approved budgets click here (will open in new window).
Acct #'s for Budget Owner - Wes Butler:*
Acct #'s for Budget Owner - Allen Tipping (Grassroots):*
Acct #'s for Budget Owner - Chris Kakaras*
Acct #'s for Budget Owner - Adam Gibson:*
Acct #'s for Budget Owner - Alice McMahan/Jon Ludovina:*
Acct #'s for Budget Owner - Jake Blair:*
Acct #'s for Budget Owner - Michelle Jahnke:*
Acct #'s for Budget Owner - Ryan Shults:*
Acct #'s for Budget Owner - Jay Hendricks:*
Acct #'s for Budget Owner - Jeremy Wilson:*
Acct #'s for Budget Owner - Jon Ludovina:*
Acct #'s for Budget Owner - Megan Rife:*
Acct #'s for Budget Owner - Andrew Flowers:*
Acct #'s for Budget Owner - Brandon Clements:*
Acct #'s for Budget Owner - Hannah Disbrow:*
Acct #'s for Budget Owner - Kirsten Ellison:*
Acct #'s for Budget Owner - Michael Bailey:*
Acct #'s for Budget Owner - Taylor Schombert:*
Acct #'s for Budget Owner - Tiffany Coker:*
Acct #'s for Budget Owner - Ant Frederick:*
Acct #'s for Budget Owner - Catherine Failoni:*
Acct #'s for Budget Owner - John Nobles:*
Acct #'s for Budget Owner - Tremon Davis:*
Enter the appropriate Residency fund account:*
Enter the appropriate 2000 account:*
Transaction 3 Description*
Transaction 3 Amount:*
Upload all receipts, invoices, etc. for Transaction #3*

Upload a File

Cancelof
Do you need a Gas Reimbursement?

YesNo
Section IV - Gas Reimbursement

Mileage is reimbursed at $0.50/mile driven. To be reimbursed for gas, you must include a map with mileage from the Midtown Offices to the location driven.
What church is this for?:*

Central (City-Wide)DowntownTwo NotchLexington
Central or Downtown budget owner who authorizes expense?*
Two Notch budget owner who authorizes expense?*
Lexington budget owner who authorizes expense?*
Grassroots Network budget owner who authorizes expense?*
To see approved budgets click here (will open in new window).
Acct #'s for Budget Owner - Wes Butler:*
Acct #'s for Budget Owner - Allen Tipping (Grassroots):*
Acct #'s for Budget Owner - Chris Kakaras*
Acct #'s for Budget Owner - Adam Gibson:*
Acct #'s for Budget Owner - Alice McMahan/Jon Ludovina:*
Acct #'s for Budget Owner - Jake Blair:*
Acct #'s for Budget Owner - Michelle Jahnke:*
Acct #'s for Budget Owner - Ryan Shults:*
Acct #'s for Budget Owner - Jay Hendricks:*
Acct #'s for Budget Owner - Jeremy Wilson:*
Acct #'s for Budget Owner - Jon Ludovina:*
Acct #'s for Budget Owner - Megan Rife:*
Acct #'s for Budget Owner - Andrew Flowers:*
Acct #'s for Budget Owner - Brandon Clements:*
Acct #'s for Budget Owner - Hannah Disbrow:*
Acct #'s for Budget Owner - Kirsten Ellison:*
Acct #'s for Budget Owner - Michael Bailey:*
Acct #'s for Budget Owner - Taylor Schombert:*
Acct #'s for Budget Owner - Tiffany Coker:*
Acct #'s for Budget Owner - Ant Frederick:*
Acct #'s for Budget Owner - Catherine Failoni:*
Acct #'s for Budget Owner - John Nobles:*
Acct #'s for Budget Owner - Tremon Davis:*
Enter the appropriate Residency fund account:*
Enter the appropriate 2000 account:*
Miles Driven*
Reimbursement Amount
Gas Reimbursement Description*
Upload all receipts, maps, etc. for your gas reimbursement*

Upload a File

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Total Reimbursement Amount:
Any Additional Notes:
Don't go anywhere. Wait time after clicking submit can be up to 30 seconds. You may sing while you wait. Once you are thanked you may leave.
Should be Empty:

MIDTOWN EXPENSE FORM

SECTION I - TO BE COMPLETED BY REQUESTOR

SECTION II - MAKE CHECK PAYABLE TO

SECTION III - SUBMIT RECEIPTS

Section IV - Gas Reimbursement