Reimbursement

1
Important

Do you possess an itemized receipt for your purchase?

An itemized receipt lists all the individual entrées and drinks for a meal, or all the individual items purchased for an event. The IRS requires us to collect itemized receipts instead of summary receipts, which only list a total amount for the purchase.
2
Church Name
3
Recipient Name* This field is required.Enter exactly as you want it to appear on the check
This may be you or it may be your church, depending on who paid for the expense.
4
Mailing Address* This field is required.To which the check will be sent
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
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Algeria
American Samoa
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Angola
Anguilla
Antigua and Barbuda
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Liberia
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Lithuania
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Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
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Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
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Niger
Nigeria
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Paraguay
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Poland
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Romania
Russia
Rwanda
Saint Barthelemy
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Other
Country
5
Recipient EmailFor contacting you if we need to clarify anything
example@example.com
6
Recipient Phone* This field is required.For contacting you if we need to clarify anything
Area Code
Phone Number
7
Reason for Expense* This field is required.Description of the purpose for the expense and event involved.
8
Recipient Church Name
Bethlehem Baptist Church
Christ Fellowship Church
Christ Redeemer Church
Cities Church
City of Joy Fellowship
Covenant Life Church
Desiring God Community Church
Église Baptiste Bethléem
Glory of Christ Fellowship
Grace Church Memphis
Gracia Sobre Gracia
Iglesia Bíblica Sublime Gracia
Jubilee Community Church
Kaleo Church
Legacy Christian Fellowship
Little Earth Fellowship
New Creation Church
Northfield Community Church
Redemption City Church Rochester
Redemption City Church Grand Rapids
Refuge Church
Restoration Church
Sojourners Church
Table Rock Church
TCT Staff
The Heights Church St Paul
The Heights Church Tampa
Treasuring Christ Church Charlotte
Treasuring Christ Church Raleigh
Urban Harvest Fellowship
9
Expenses List* This field is required.Please list each individual receipt in a separate row. You will be asked to upload the receipts on the next screen.
Purchase Date
Expense Category
Amount on Receipt
Amount Requested
1
Row 0, Column 0
Airfare
Retreat Activities (Bikes, Beach, etc.)
Lead Team Meals
Network Meals
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
2
Row 1, Column 0
Airfare
Retreat Activities (Bikes, Beach, etc.)
Lead Team Meals
Network Meals
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
3
Row 2, Column 0
Airfare
Retreat Activities (Bikes, Beach, etc.)
Lead Team Meals
Network Meals
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
4
Row 3, Column 0
Airfare
Retreat Activities (Bikes, Beach, etc.)
Lead Team Meals
Network Meals
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
5
Row 4, Column 0
Airfare
Retreat Activities (Bikes, Beach, etc.)
Lead Team Meals
Network Meals
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
1
2
3
4
5
Purchase Date
Row 0, Column 0
Expense Category
Airfare
Retreat Activities (Bikes, Beach, etc.)
Lead Team Meals
Network Meals
Row 0, Column 1
Amount on Receipt
Row 0, Column 2
Amount Requested
Row 0, Column 3
Purchase Date
Row 1, Column 0
Expense Category
Airfare
Retreat Activities (Bikes, Beach, etc.)
Lead Team Meals
Network Meals
Row 1, Column 1
Amount on Receipt
Row 1, Column 2
Amount Requested
Row 1, Column 3
Purchase Date
Row 2, Column 0
Expense Category
Airfare
Retreat Activities (Bikes, Beach, etc.)
Lead Team Meals
Network Meals
Row 2, Column 1
Amount on Receipt
Row 2, Column 2
Amount Requested
Row 2, Column 3
Purchase Date
Row 3, Column 0
Expense Category
Airfare
Retreat Activities (Bikes, Beach, etc.)
Lead Team Meals
Network Meals
Row 3, Column 1
Amount on Receipt
Row 3, Column 2
Amount Requested
Row 3, Column 3
Purchase Date
Row 4, Column 0
Expense Category
Airfare
Retreat Activities (Bikes, Beach, etc.)
Lead Team Meals
Network Meals
Row 4, Column 1
Amount on Receipt
Row 4, Column 2
Amount Requested
Row 4, Column 3
1 of 5
10
I would like to provide my receipts by
uploading a file (for multiple)
take a picture for one receipt
11
Take a photo of your receipt.
12
Receipt(s) Upload
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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