Payment Request Form

To be used to record expenditures incurred by Greater North Shore Full Gospel Baptist Church

Date of Request Date of Request / MM / DD YYYY
Requester's Name Requester's Name First Last
Ministry Name
Date Needed Date Needed / MM / DD YYYY
Proposal Previously Submitted

Proposal Previously Submitted Yes No
Reason for Request
Reimbursement Information

Please fill this portion out entirely.
Name of Payee Name of Payee First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Reimbursement Total $ Dollars . Cents
Upload Copy of all Receipt

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