2024 Receipt Submission/Payment Request

2024 Receipt Submission/Payment Request

This form is to be utilized for any receipt submission, reimbursement or invoice payment request.
Name*

First NameLast Name
Email
example@example.com
Position
Type of Submission*

Request Payment (pay vendor or reimbursement)Submit a ReceiptSubmit a Refund Notice
Type of Request

New InvoiceReimbursement
Reimburse to*

Employee via PayrollVendor via Check
Vendor/Store Name*
MonthDayYear
Amount*
Invoice Number
Receipt Submitted By

First NameLast Name
Purpose of Purchase*
Purchased by*

First NameLast Name

Payment Information

Only required for Receipt Submissions.
Form of Payment*
Check Number
Gift Card Numbers
Enter SHTN assigned gift card numbers and separate with a backslash "/"
Total Spent on Gift Cards
Total Spent on Credit Card

Budget Lines

Please select the correct budget line for this purchase.
Department*
Garland Oaks Budget

ProgramFacilitiesTransportation
Program
Facilities
Transportation
Street Hope Budget
Event Planning & Fundraising

Annual Appeal - ExpensesDevelopment for Donor SearchEvent Advertising/PromotionHope Will Rise
Prevention Budget
Attach Receipt*

Browse Files
Please take a clear photo that shows the purchases and total payment Cancelof
Notes
Should be Empty:

Payment Information