Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.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 *PortageVicksburgWhich 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? *YESNO Member of FIRST Description 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
