ST.
JAMES EPISCOPAL CHURCH
PURCHASE REQUEST
Please complete this form
and submit it to the Church Office for approval anytime you plan to request a
reimbursement for money spent on behalf of St. JamesÌ Episcopal Church.__ Please complete all numbered sections._ You may mail, fax, or email the form to the
Church Office._ If the expenditure is
approved, a copy of the form noting the approval will be sent back to you._ To obtain reimbursement for the expenditure,
attach a signed copy of this form to the receipt for the expenditure and mail
or deliver the form and receipt to the Church Office.
1.
Name of person
making request: _________________ _________________ _________________ _________________
2.
Contact telephone
number(s) of the person making the request: ___ _________________ _________________ _____
3.
Í_ I am requesting that a check be issued to
the following named company or individual for the below-listed purpose:
Name and address :_ ______ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________
Í
I am requesting
authority to expend funds and be reimbursed.
4.
Amount of the
Request:_ Í (not
to exceed):_ $ _________________ Í
(exact amount) $_ _________________
5.
Purpose of the expenditure:_ ____________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________
6.
This expenditure
should be charged to budget item (name or number)
_________________________________
7.
Here is the
signature of the person responsible for managing this budget line item__ __________________________________
8.
Please return the
completed form to the person making the request via:
q Mail :_
(mailing address): _______ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________
q Fax (fax number): _______ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________
q Email (email address: ) ______ ___________ ___________ ___________ ___________ ___________ ___________ ___________
9.
(If requesting
reimbursement) Please mail the check to:
q Requestor (address): _______ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________
q Other (name and address): _______ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________
10.
Signature of person
making the request: ___ _________________ _________________ _________________ _________________
Request_ No. __ _______________________ _______________________
This request is:
q
Approved for
(Amount):_ __ _____ _____ _____ _____ _____ _____ _____ _____
q
Disapproved._ (Reason) _ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____
Approval signature:
_______________________ _______________________ _______________________ _______________________
Rector/Senior
Warden/Other (title) ______________ _______________________