Expense Reimbursement Form

** Expenses need to be submitted within 90 days of the transaction.**
Please contact Marie Kim at marie.kim@churchofsouthland.com with any questions.

Your name *

Email address *

Address *

Phone number *

Check Payable To: *

Check Delivery Option

Do not mail check. I would like to pick up the check from Church.

Ministry *

Please select which Ministry the expense was for.

If Other, please specify

Expense #1

Expense #1 Date *

Expense #1 Details *

Please include vendor and description of purchase / purpose

Expense #1 Cost Amount

Scan/Picture of Receipt

Please upload in .jpg .png or .pdf format only
Physical receipts may also be submitted to Marie Kim.

No files currently selected

Add up to 5 files. Maximum file size 10 MB.

Expense #2

Expense #2 Date

Expense #2 Details

Please include vendor and description of purchase / purpose

Expense #2 Cost Amount

Scan/Picture of Receipt

Please upload in .jpg .png or .pdf format only
Physical receipts may also be submitted to Marie Kim.

No files currently selected

Add up to 5 files. Maximum file size 10 MB.

Expense #3

Expense #3 Date

Expense #3 Details

Please include vendor and description of purchase / purpose

Expense #3 Cost Amount

Scan/Picture of Receipt

Please upload in .jpg .png or .pdf format only
Physical receipts may also be submitted to Marie Kim.

No files currently selected

Add up to 5 files. Maximum file size 10 MB.

Expense #4

Expense #4 Date

Expense #4 Details

Please include vendor and description of purchase / purpose

Expense #4 Cost Amount

Scan/Picture of Receipt

Please upload in .jpg .png or .pdf format only
Physical receipts may also be submitted to Marie Kim.

No files currently selected

Add up to 5 files. Maximum file size 10 MB.

Expense #5

Expense #5 Date

Expense #5 Details

Please include vendor and description of purchase / purpose

Expense #5 Cost Amount

Scan/Picture of Receipt

Please upload in .jpg .png or .pdf format only
Physical receipts may also be submitted to Marie Kim.

No files currently selected

Add up to 5 files. Maximum file size 10 MB.

TOTAL

Expenses Total

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