Check Request Form

If you have incurred expenses on behalf of Saint Mark while helping to prepare for one of its events, please complete and submit this form.

The Finance Office may need to contact you for more information, including copies of receipts or invoices - as required by our auditors. Please provide all contact information.

Your Information:

First Name: * required

Last Name: * required

Email: * required

Phone: * required

Make Payment/Reimbursement to:

Name:

Street Address 1:

Street Address 2:

City:   State:   Zip:

Would you like payment/reimbursement check mailed to the address above or will you pick it up in the church office? Mail Pick-up

Make Payment/Reimbursement to:

Amount to be paid/reimbursed: $

Name of requesting Saint Mark committee or ministry:

General Ledger Account, if known:

Please provide an explanation of this payment/reimbursement, including the date of use: