Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. & Last CREDIT CARD RECEIPT ENTRY Please complete this form if you charged anything on a church CREDIT CARD Today's Date *Email *Name on Credit Card – FIRST & LAST *Campus *PortageVicksburgPurpleWhich credit card? *Advia Credit UnionCapital OneHonor Credit UnionEnter Last Four Digits of your Credit Card *Purchase Date *Store *Do you have more than one account associated with this purchase? *YESNODescription of Items Purchased: *Account # *Amount *Description of Items Purchased: *Account # Amount Description of Items Purchased: Account # Amount Description of Items Purchased: Account # Amount Upload Images of Receipts PDF Preferred * Drag & Drop Files, Choose Files to Upload You can upload up to 4 files. Receipts are required for reimbursementApproved by Staff Member – FIRST & LAST *Total Charge$0.00Submit
