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Payment Request Form
By submitting this form, you authorize the designated amount to be paid from your AP account
Upload invoice or receipts to be paid or reimbursed. All reimbursements and vendor payments must have corresponding receipts/payments submitted here before payment can be made.
Drop files here or
Max. file size: 50 MB.
MM slash DD slash YYYY
Name of Your Organization (Alliance Partner name)
Must submit receipts and invoices for reimbursements and vendor payments - use the file upload above.
Reimbursement request (for out-of-pocket expenses)
Vendor Payment (for goods or services Vendors from 3rd party, including contract labor)
Mileage Reimbursement (mileage driven for mission purposes, not commuting)
Funds-In-Advance (requesting a check in advance of purchase, this is rare)
For reimbursements, mileage, contract labor, and vendors
Direct Deposit (preferred)
Check by mail
Name of person to receive the Direct Deposit
Make check payable to:
Address Line 2
State / Province / Region
ZIP / Postal Code
Check if this address is updating the information we previously had on file
For Direct Deposit
For each person or company who is to be paid by direct deposit, we must have a signed Direct Deposit Authorization Form submitted by the Executive Director giving us permission to set up a direct deposit payment. If you do not have one on file for this payee - see the statement in red at the top of the page. The form must be submitted before a direct deposit can be made.
Check here to confirm a Direct Deposit Authorization has been submitted
Accounts and Designations
Tell us what expense account(s) to use to record your reimbursement, vendor payment, mileage, or advanced funds. List Accounts Separately: (refer to your AP Chart of Accounts for account numbers) Use the + button to add additional rows IF YOU AREN’T SURE WHICH ACCOUNT TO USE, WRITE A DETAILED DESCRIPTION AND WE WILL CHOSE THE APPROPRIATE ACCOUNT
If you don't know what account to use above, write a detailed description so we can choose the appropriate account
For Mileage Reimbursement: Please complete the Payee Information and Payment Method sections on page 1. Then use the formula below to find the total amount. The amount will be automatically accounted to your Mileage Account, usually Account # 800
Total trip mileage: __________ miles X .58 = $___________ ($ to be reimbursed)
Explanation of trip:
Funds In Advance
Under special circumstances, we can issue a payment in advance of the expense being incurred. A common example might be group travel expenses, like food or lodging, when large amounts will be spent and you prefer not to pay out-of-pocket and be reimbursed later. Also, occasionally event vendors require payments/deposits before an official invoice is issued.
1) Please complete the Payee Information and Payment Method sections above.
2) Describe what the requested funds will be used for:
3) Estimate the anticipated costs. How much do you need in advance?
4) Receipts must be submitted within 15 days documenting reasonable ministry use of all funds.
If receipts are not received (up to the amount paid in advance), you will either need to return the unused funds OR we will process it as Contract Labor (aka taxable income to the Payee).
I will provide receipts within 15 days
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