Expense Report/Reimbursement Request Expense Report/Reimbursement Request

Amount $ _________________ Amount $ _________________

Pay to the Order of: _____________________________________ Pay to the Order of: _____________________________________

Expense / Reimbursement Description: Expense / Reimbursement Description:

Departmental Usage: Departmental Usage:

( ) Office Supplies ( ) Office Supplies
( ) Food/Fellowship ( ) Food/Fellowship
( ) Pastoral ( ) Pastoral
( ) Other ( ) Other
* ____________________ * ____________________

Date:______ / ______ / ______ Date:______ / ______ / ______

Person Requesting: ________________________________ Person Requesting: ________________________________

Signature 1: _______________ Signature 2: ________________ Signature 1: _______________ Signature 2: ________________

Check # __________ Check # __________