Cornerstone Bible Church Expense Reimbursement Form

Date of Request

MM

DD

YYYY

Name

First Name

Last Name

Phone Number

(###)

###

####

Email Address

Ministry Head who approved expense

Ministry Area for Expense

What Line Item from the Budget does this expense apply to?

Amount Spent

$

Reimbursement Required?

Yes - Reimburse by Check

No - Expense made on Credit Card

No - Expense was a special gift purchase

If "Yes" for reimbursement

Where do you want the check?

Address

Mailing Address if reimbursement by Check

Reason for Purchase