Check Request

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Check Request

CHLB - DDD Reimbursement Form General Operating Fund

Payee:

Date:

Address: City, State, Zip: Project Name:

Small Group Name:

Note: Central Baptist does NOT reimburse tax, please do not include sales tax in reimbursement total. Please include original reciepts with your reimbursement request. Description of Item(s) Date of Purchase

Please describe each reciept one per line

Account Number(Office Use)

Total: Please check one:

Requested By:

Hold Check:

Date:

Mail Check:

Approved By:

Date:

Additional Information:

Total