Check Request Form

Date *

Type of Request: *DISBURSEMENT REQUESTREIMBURSEMENT REQUEST

Amount of Request: *

Date(s) Purchased/Needed: *

Requested By: *

Description of Expense/Expenditure: *

Make Check Payable To: *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Contact Phone Number: *

Email Address:

Documentation Submitted (original receipt, invoice, purchase order, etc.) *

Upload file

No file chosen

Ministry to be charged: *WMSLay OrganizationYPDSteward BoardTrustee Board

Ministry Approval: *

Approval Date *

FOR CHURCH USE ONLY

Form Received By: *

Date *

Pastor's Approval: *

Approval: *

Check# *

Date *

Funds used to date:

USD

of Budget:

USD

Remaining Conference Year Budget:

USD

Please do not fill in this field.

1177 West 25th Street, Los Angeles, CA 90007

Tel: (213) 747-1367