Reimbursement/Payment Request

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If you have purchased supplies or need payment for a First Parish activity, you can request reimbursement using this form. Please include which account should be charged. If you’re not sure, include a description of the committee or activity the purchase or payment was for.

Reimbursement or Payment Request

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Next Steps: Install a Payment Add-On

To accept payments on this form you will need to install one of our payment add-ons. To learn more about your payment add-on options, visit the following page (https://www.gravityforms.com/blog/payment-add-ons). Important: Delete this tip before you publish the form.

Your Name(Required)

First Last

Your Email(Required)

Enter Email Confirm Email

Full legal name of the person/company receiving payment (payee).(Required)

First Last

Payee's email address(Required)

Enter Email Confirm Email

Payee's Phone Number

Full mailing address of person/company receiving payment.(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Payment delivery

Email address of committee or staff member approving request

Total amount requested for reimbursement or payment *

Where should the expense be charged?

Include the line item if known OR verbal description of committee or function for accounting purposes.

Explanation of expense(Required)

Date of event or service(Required)

Upload your Receipts, Invoices, or W9

Drop files here or

Max. file size: 128 MB.

If you are requesting reimbursement you are required to submit a copy of your receipts. PDF or JPG files are preferred. No word processing documents will be accepted. Please note that requests submitted take 2-3 weeks to process. If you would like to check on your request or if you have still not received a check after 3 weeks, you may email office@firstparish.info to inquire after your submission.

Date