Receipt Form
Required for all purchases made with a PEX pre-paid credit card, store cash card, or other means of payment other than personal funds to be reimbursed.
Your Info
Your Info
Name
*
First Name
Last Name
Email
*
yourname@ctk.church
Submitting For
Self
Someone Else
Who are you submitting this for?
First Name
Last Name
Receipt Info
Receipt Info
You can enter up to 10 receipts at a time. Please include all relevant details, in including an image or PDF copy of your receipts.
What kind of receipt(s) are you submitting?
*
Ministry/Operations
Blessing
Are you submitting these receipts to reconcile a cash advance?
*
Yes
No
Back
Next
How many receipts would you like to submit?
*
Are all receipts for the same department & budget?
*
Yes
No
Are any of your receipts associated with a Purchase Request?
*
Yes
No
Are all receipts on the same Purchase Request?
*
Yes
No
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Campus, Department, & Budget
*
Receipt Info
Please include all relevant details, in including an image or PDF copy of your receipts.
Receipt #1 Info
Purchase Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #1 Campus, Department, & Budget
Description of Purchase
*
Vendor/Store Name
*
Payment Type
*
Please Select
PEX Card
Store Cash Card
--Choose one--
Card Name
*
Last 4 Digits of Card or Check #
*
Purchase Total
*
Blessing Account
*
Please Select
Blessing - General
Blessing - Benevolence
Blessing - Counseling/Scholarships
FS & F - Supplies
FS & F - Equipment
FS & F - Events
FS & F - General
FS & F - Improvements
FS & F - Vehicle
FS & F - Volunteer
Local Partners - Partner Support
Local Partners - General
Local Partners - Ministry Projects
Local Partners - One-Time Projects
Local Partners - Response Teams
Card Used
*
Please Select
John Williams PEX - 5998
Scott Roberts PEX - 5142
Bob Bethke PEX - 4983
Edward Schild PEX - 6538
Blessing Volunteer 1 PEX - 4829
Blessing Volunteer 2 PEX - 8598
Blessing Volunteer 3 PEX - 9094
Blessing Volunteer 4 PEX - 0473
Blessing Volunteer 5 PEX - 6158
Upload Receipt #1
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt #2 Info
Receipt #2 Campus, Department & Budget
*
Purchase Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Description of Purchase
*
Vendor/Store Name
*
Purchase Total
*
Payment Type
*
Please Select
PEX Card
Store Cash Card
--Choose one--
Card Name
*
Last 4 Digits of Card or Check #
*
Blessing Account
*
Please Select
Blessing - General
Blessing - Benevolence
Blessing - Counseling/Scholarships
FS & F - Supplies
FS & F - Equipment
FS & F - Events
FS & F - General
FS & F - Improvements
FS & F - Vehicle
FS & F - Volunteer
Local Partners - Partner Support
Local Partners - General
Local Partners - Ministry Projects
Local Partners - One-Time Projects
Local Partners - Response Teams
Card Used
*
Please Select
John Williams PEX - 5998
Scott Roberts PEX - 5142
Bob Bethke PEX - 4983
Edward Schild PEX - 6538
Blessing Volunteer 1 PEX - 4829
Blessing Volunteer 2 PEX - 8598
Blessing Volunteer 3 PEX - 9094
Blessing Volunteer 4 PEX - 0473
Blessing Volunteer 5 PEX - 6158
Upload Receipt #2
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt #3 Info
Purchase Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #3 Campus, Department & Budget
*
Description of Purchase
*
Vendor/Store Name
*
Purchase Total
*
Payment Type
*
Please Select
PEX Card
Store Cash Card
--Choose one--
Card Name
*
Last 4 Digits of Card or Check #
*
Blessing Account
*
Please Select
Blessing - General
Blessing - Benevolence
Blessing - Counseling/Scholarships
FS & F - Supplies
FS & F - Equipment
FS & F - Events
FS & F - General
FS & F - Improvements
FS & F - Vehicle
FS & F - Volunteer
Local Partners - Partner Support
Local Partners - General
Local Partners - Ministry Projects
Local Partners - One-Time Projects
Local Partners - Response Teams
Card Used
*
Please Select
John Williams PEX - 5998
Scott Roberts PEX - 5142
Bob Bethke PEX - 4983
Edward Schild PEX - 6538
Blessing Volunteer 1 PEX - 4829
Blessing Volunteer 2 PEX - 8598
Blessing Volunteer 3 PEX - 9094
Blessing Volunteer 4 PEX - 0473
Blessing Volunteer 5 PEX - 6158
Upload Receipt #3
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt #4 Info
Purchase Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #4 Campus, Department & Budget
*
Description of Purchase
*
Vendor/Store Name
*
Purchase Total
*
Payment Type
*
Please Select
PEX Card
Store Cash Card
--Choose one--
Card Name
*
Last 4 Digits of Card or Check #
*
Blessing Account
*
Please Select
Blessing - General
Blessing - Benevolence
Blessing - Counseling/Scholarships
FS & F - Supplies
FS & F - Equipment
FS & F - Events
FS & F - General
FS & F - Improvements
FS & F - Vehicle
FS & F - Volunteer
Local Partners - Partner Support
Local Partners - General
Local Partners - Ministry Projects
Local Partners - One-Time Projects
Local Partners - Response Teams
Card Used
*
Please Select
John Williams PEX - 5998
Scott Roberts PEX - 5142
Bob Bethke PEX - 4983
Edward Schild PEX - 6538
Blessing Volunteer 1 PEX - 4829
Blessing Volunteer 2 PEX - 8598
Blessing Volunteer 3 PEX - 9094
Blessing Volunteer 4 PEX - 0473
Blessing Volunteer 5 PEX - 6158
Upload Receipt #4
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt #5 Info
Purchase Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #5 Campus, Department & Budget
*
Description of Purchase
*
Vendor/Store Name
*
Purchase Total
*
Payment Type
*
Please Select
PEX Card
Store Cash Card
--Choose one--
Card Name
*
Last 4 Digits of Card or Check #
*
Blessing Account
*
Please Select
Blessing - General
Blessing - Benevolence
Blessing - Counseling/Scholarships
FS & F - Supplies
FS & F - Equipment
FS & F - Events
FS & F - General
FS & F - Improvements
FS & F - Vehicle
FS & F - Volunteer
Local Partners - Partner Support
Local Partners - General
Local Partners - Ministry Projects
Local Partners - One-Time Projects
Local Partners - Response Teams
Card Used
*
Please Select
John Williams PEX - 5998
Scott Roberts PEX - 5142
Bob Bethke PEX - 4983
Edward Schild PEX - 6538
Blessing Volunteer 1 PEX - 4829
Blessing Volunteer 2 PEX - 8598
Blessing Volunteer 3 PEX - 9094
Blessing Volunteer 4 PEX - 0473
Blessing Volunteer 5 PEX - 6158
Upload Receipt #5
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt #6 Info
Purchase Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #6 Campus, Department & Budget
*
Description of Purchase
*
Vendor/Store Name
*
Purchase Total
*
Payment Type
*
Please Select
PEX Card
Store Cash Card
--Choose one--
Card Name
*
Last 4 Digits of Card or Check #
*
Blessing Account
*
Please Select
Blessing - General
Blessing - Benevolence
Blessing - Counseling/Scholarships
FS & F - Supplies
FS & F - Equipment
FS & F - Events
FS & F - General
FS & F - Improvements
FS & F - Vehicle
FS & F - Volunteer
Local Partners - Partner Support
Local Partners - General
Local Partners - Ministry Projects
Local Partners - One-Time Projects
Local Partners - Response Teams
Card Used
*
Please Select
John Williams PEX - 7961
Scott Roberts PEX - 5142
Bob Bethke PEX - 4983
Edward Schild PEX - 6538
Blessing Volunteer 1 PEX - 4829
Blessing Volunteer 2 PEX - 8598
Blessing Volunteer 3 PEX - 9094
Blessing Volunteer 4 PEX - 0473
Blessing Volunteer 5 PEX - 6158
Upload Receipt #6
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt #7 Info
Purchase Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #7 Campus, Department & Budget
*
Description of Purchase
*
Vendor/Store Name
*
Purchase Total
*
Payment Type
*
Please Select
PEX Card
Store Cash Card
--Choose one--
Card Name
*
Last 4 Digits of Card or Check #
*
Blessing Account
*
Please Select
Blessing - General
Blessing - Benevolence
Blessing - Counseling/Scholarships
FS & F - Supplies
FS & F - Equipment
FS & F - Events
FS & F - General
FS & F - Improvements
FS & F - Vehicle
FS & F - Volunteer
Local Partners - Partner Support
Local Partners - General
Local Partners - Ministry Projects
Local Partners - One-Time Projects
Local Partners - Response Teams
Card Used
*
Please Select
John Williams PEX - 5998
Scott Roberts PEX - 5142
Bob Bethke PEX - 4983
Edward Schild PEX - 6538
Blessing Volunteer 1 PEX - 4829
Blessing Volunteer 2 PEX - 8598
Blessing Volunteer 3 PEX - 9094
Blessing Volunteer 4 PEX - 0473
Blessing Volunteer 5 PEX - 6158
Upload Receipt #7
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt #8 Info
Purchase Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #8 Campus, Department & Budget
*
Description of Purchase
*
Vendor/Store Name
*
Purchase Total
*
Payment Type
*
Please Select
PEX Card
Store Cash Card
--Choose one--
Card Name
*
Last 4 Digits of Card or Check #
*
Blessing Account
*
Please Select
Blessing - General
Blessing - Benevolence
Blessing - Counseling/Scholarships
FS & F - Supplies
FS & F - Equipment
FS & F - Events
FS & F - General
FS & F - Improvements
FS & F - Vehicle
FS & F - Volunteer
Local Partners - Partner Support
Local Partners - General
Local Partners - Ministry Projects
Local Partners - One-Time Projects
Local Partners - Response Teams
Card Used
*
Please Select
John Williams PEX - 5998
Scott Roberts PEX - 5142
Bob Bethke PEX - 4983
Edward Schild PEX - 6538
Blessing Volunteer 1 PEX - 4829
Blessing Volunteer 2 PEX - 8598
Blessing Volunteer 3 PEX - 9094
Blessing Volunteer 4 PEX - 0473
Blessing Volunteer 5 PEX - 6158
Upload Receipt #8
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt #9 Info
Purchase Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #9 Campus, Department & Budget
*
Description of Purchase
*
Vendor/Store Name
*
Purchase Total
*
Payment Type
*
Please Select
PEX Card
Store Cash Card
--Choose one--
Card Name
*
Last 4 Digits of Card or Check #
*
Blessing Account
*
Please Select
Blessing - General
Blessing - Benevolence
Blessing - Counseling/Scholarships
FS & F - Supplies
FS & F - Equipment
FS & F - Events
FS & F - General
FS & F - Improvements
FS & F - Vehicle
FS & F - Volunteer
Local Partners - Partner Support
Local Partners - General
Local Partners - Ministry Projects
Local Partners - One-Time Projects
Local Partners - Response Teams
Card Used
*
Please Select
John Williams PEX - 5998
Scott Roberts PEX - 5142
Bob Bethke PEX - 4983
Edward Schild PEX - 6538
Blessing Volunteer 1 PEX - 4829
Blessing Volunteer 2 PEX - 8598
Blessing Volunteer 3 PEX - 9094
Blessing Volunteer 4 PEX - 0473
Blessing Volunteer 5 PEX - 6158
Upload Receipt #9
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt #10 Info
Purchase Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Purchase Request (PR) Number
(if applicable – e.g. PR-1001)
Receipt #10 Campus, Department & Budget
*
Description of Purchase
*
Vendor/Store Name
*
Purchase Total
*
Payment Type
*
Please Select
PEX Card
Store Cash Card
--Choose one--
Card Name
*
Last 4 Digits of Card Number or Check Number
*
Blessing Account
*
Please Select
Blessing - General
Blessing - Benevolence
Blessing - Counseling/Scholarships
FS & F - Supplies
FS & F - Equipment
FS & F - Events
FS & F - General
FS & F - Improvements
FS & F - Vehicle
FS & F - Volunteer
Local Partners - Partner Support
Local Partners - General
Local Partners - Ministry Projects
Local Partners - One-Time Projects
Local Partners - Response Teams
Card Used
*
Please Select
John Williams PEX - 5998
Scott Roberts PEX - 5142
Bob Bethke PEX - 4983
Edward Schild PEX - 6538
Blessing Volunteer 1 PEX - 4829
Blessing Volunteer 2 PEX - 8598
Blessing Volunteer 3 PEX - 9094
Blessing Volunteer 4 PEX - 0473
Blessing Volunteer 5 PEX - 6158
Upload Receipt #10
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt Upload
Upload All Receipts
Browse Files
Drag and drop files here
Choose a file
Please attach up to ten receipts associated with this submission.
Cancel
of
Review Submission
Please review your submission for errors & ensure all files are attached before submitting.
Submit
Should be Empty: