GRASSROOTS General Purchases & Reimbursements Form ; Checks are cut, signed and mailed on the 1st day of each month. Should this online form be broken, you may download, print, and complete the General Purchases/Reimbursements 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 email the GRASSROOTS Church Council. You must upload clear PDF scans of original receipts (circle the DATE and TOTAL cost) using a scanner or the Adobe Scan phone app. Bank or credit card statements are not permitted. 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* Reimbursement or Purchase RecordReimbursement/Purchase Record Selection*This is a reimbursement request for items I've purchased on behalf of GRASSROOTS Church using my own funds.This is a record of items I've purchased on behalf of GRASSROOTS Church using church funds (debit, check, cash).Field GuidelinesYou 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 Account: 4 digit account number from a budget catagory Description: The items purchased and their ministry purpose 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.DateAccountDescriptionVendorPrice Total Reimbursement AmountTotal Purchase AmountUpload Receipts*Submit 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.EmailThis 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.