Today's Date PO# (for office use) _____________
Name of Payee Phone
Address of Payee City State Zip
Amount of Expense Date Needed
Description of Expense
Dept. to be charged: Account #
Is this expense in your 2006 budget? Yes No
How will this expense be paid for? Church Check Church Account Church Credit Card GPH Account Reimbursement Other Payment
Person Filling Out This Form
Approved By _______________________________ (for office use)