Payment Requisition Form

請用英文清楚填寫表格，多謝! Please fill out the form clearly in English. Thank you!

( Section 1: Requester and Purchase Information

Requester’s Name	Phone #
Event Name	Department

-國語堂 -粵語堂 -Eng Cong.
Purchase Item(s) Description
Calculations
Check if estimated	1. Original receipt, invoice, or appropriate documents must be attached.

2. Circle the total cost of goods or services.

3. If necessary, please use separate sheet to itemize/calculate your total.

4. Please explain in Remarks any special situations (e.g. receipt is missing).
( Section 2: Payment Details

Payment Type

(check one)	Advance

Payment

Reimbursement	Source Fund

(check one)	General Fund
(must write account # below)

Other:
Payment Instructions

(check one)	Check: Put in requester’s mailbox

Check: Mail to payee (fill in name & address below)

Petty Cash: Pick up by requester

Other:	General Fund Budget
Account #	Amount
Payee’s Name

and Address	Same as Requester

Total:
Signatures	Requester

Date

Endorsement (e.g. Pastor, Deacon, PC Chair)

|	Date

Approval (e.g. Treasurer, Accounting Supervisor, Finance Deacon)

|	Date

Remarks
* Under normal circumstances, it takes 2 weeks to prepare a check; in case of urgency, please follow Emergency Check procedures.

( Payment Record (Do Not Complete – Internal Use Only)

Payee Name
Check Number
Bank Name
Check Date
Bank Account
Check Amount	$
Input Date
Input By
Check Acct #

ver. 01.2008

Payment Requisition Form v2. 4/2008

Peter Chan

2008-01-14

First Evangelical Church SGV