Unique ID

Request Type*

Date of Transaction*

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Vendor Name*

Purchase Description:*

Please list all items on this purchase.

Item Description	Quantity	Rate	Amount

Amount Total

Budget Category*

Select below with the most accurate budget category for this expense:

Office Sub Category

Finance Sub Category

SPPRC Sub Category

Trustees Sub Category

Outreach Sub Category

Ministries Sub Category

Worship Sub Category

Pastor Sub Category

Please attach receipts for this purchase*

Receipts for all line items are required for reimbursement.

Drop files here or

Name

This field is for validation purposes and should be left unchanged.

First UMC Lafayette

Sharing the Love of God through worship, education and outreach.