Funds Request Form — Salem United Methodist Church

FUNDS REQUEST

Submit receipts within 30 days of expenditures

AFFECTED FUND/EXPENSE

Amount of Transaction

$

Date of Transaction

MM

DD

YYYY

Pay to the Order Of

Payee Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date to be Paid By

MM

DD

YYYY

***Note: Checks are generally cut on the 1st and 3rd Sunday of the month