REIMBURSEMENT FORM Submitted by: First Name Last Name Date MM DD YYYY Email Phone (###) ### #### Check box if address on file is to be used Use address on file Address for Check (if not on file) Address 1 Address 2 City State/Province Zip/Postal Code Country At the address noted above, please make check payable to GRAND TOTAL $ Store / Company Amount $ Please indicate how you will submit the accompanying receipt: Digital image of receipt will be emailed to accounting@bridgewood church.com (PREFERRED) Yes No Physical receipt will be dropped off in the wall safe at the Bridgewood office Yes No Item used for Class code Store/Company Amount $ Please indicate how you will submit the accompanying receipt: Digital image of receipt will be emailed to accounting@bridgewood church.com (PREFERRED) Yes No Physical receipt will be dropped off in the wall safe at the Bridgewood office Yes No Item used for Class Code Store/Company Amount Please indicate how you will submit the accompanying receipt: Digital image of receipt will be emailed to accounting@bridgewood church.com (PREFERRED) Yes No Physical receipt will be dropped off in the wall safe at the Bridgewood office Yes No Item used for Class code Store/Company Amount $ Please indicate how you will submit the accompanying receipt: Digital image of receipt will be emailed to accounting@bridgewood church.com (PREFERRED) Yes No Physical receipt will be dropped off in the wall safe at the Bridgewood office Yes No Item used for Class code Please allow 7 days after submission for your reimbursement. You will receive an email once your reimbursement is in proess and on its way. Thank you for your ministry. Reimbursement checks will be sent directly from the bank to your home. Please be on the lookout for a bank-process, tear-off-edges check. Please be sure to keep the business office apprised of any address changes in order to receive your reimbursements in a timely manner. Please add this to my tax deductible contribution receipt Yes Thank you!
