Funds Disbursement Request

This form is for ministry leaders and church staff who are seeking a funds disbursement (aka check request) for approved expenses.

Fill out the form completely. An address and phone number is required if payable is a new vendor or has had a change of contact information.
Upload any supporting documentation for our records. (invoice, quote,...). Requests that are missing documentation may be denied.
Click Submit.

Please allow up to three business days for processing. If a funds disbursement is needed more urgently please submit this form, then email pastorscott@myradiuschurch.org

Name*

First NameLast Name

Email*

example@example.com

Phone Number

Please enter a valid phone number.

Type of Disbursement*

Provide check to 3rd party based upon invoice/quoteReimburse for expense(s) prepaid by requestor

Payee Company / Individual Name*

Payee Phone Number

Please enter a valid phone number.

Payee Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Qualified Expense

	Vendor	Description	Ministry	Code*	Cost
1

Qualified Expense(s) Breakdown

	Vendor	Description	Ministry	Code*	Cost
1
2
3
4
5

*Coding for Ministry Budgeting Purposes

A - Party, Banquet, Special Event

B - Conference, Growth, Camps

C - Volunteer/Staff, Gifts, Meals, Training

D - Mission Trips, Evanglism, Outreach

E - Other (Staff Use)

Total Disbursement Requested*

If check amount needs to be blank, enter "0"

Submit Supporting Documentation

File Submission

Best for Electronic Doucments

Provide Check Via*

Additional Information

By submitting this request, I agree the above statements are true and correct documentation of receipts and/or other items of proof are hereby attached to verify amounts listed. *

Funds Disbursement Request

Requestor Information