Gospel Community Leader Reimbursements Form ; Checks are cut, signed and mailed on the 1st day of each month. It's your responsibility to complete and submit this online form by the end of the previous month. Should this online form be broken, you may download, print, and complete the GC Leader Reimbursement Form, scan it to PDF and email it with all scanned receipts to firstname.lastname@example.org. If you have any questions about WHAT may be reimbursed, please reference the current GC Leader Reimbursement Policy. Clear PDF scans of original receipts must be uploaded (circle the DATE and TOTAL cost). Use a scanner or the Adobe Scan phone app. Bank/CC statements are not permitted. Only receipts that are dated within 60 days of submission will be reimbursed. Receipts that are more than 60 days old will not be reimbursed and become the personal expense of the purchaser. The value of these purchase(s) will be deducted from the total reimbursement and the receipt(s) will be returned. After you have submitted the online form, print the PDF summary attached to your email confirmation, attach the original receipts, and store it for record keeping. This will also aid the accounting team should further questions arise. Contact InformationName* First Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Phone*Contact Email* Purchases for ReimbursementYou may add rows below up to a total of 15 purchases. If you have more than 15 purchases to record, please submit a second form. Date: The proper format is MM-DD-YYYY Items: The items purchased for reimbursement Ministry: Ministry purpose and names of those involved Vendor: Name of the seller (business, person, etc.) Price: Cost of the items purchased from the Vendor (i.e. $52.32) Purchase Record*Click the + to the right of the Price field to add another row.DateItemsMinistryVendorPrice Total Reimbursement AmountThis can not exceed $200 in a given monthUpload ReceiptsSubmit clear PDF scans of original receipts (circle the DATE and TOTAL cost). Use a scanner or the Adobe Scan phone app. If the receipt is not clear when scanned, you may alternatively take a picture of the receipt. Drop files here or Signature*If using a phone or tablet, please use your finger to sign. However, if you are on a laptop or desktop computer, please use your mouse.NameThis field is for validation purposes and should be left unchanged. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.