Purchase/PEX Request Form

Please submit requests at least 1 week in advance to allow time for approval.
*** Checks are made available on Thursday.

Your name *

Email address *

Ministry/ Department *

Date Required *

Purpose *

Please provide a brief description explaining why you need to purchase these items or services for your department/ministry.
e.g. Communion Sunday July 19, 2020

Vendor Information

Name

e.g. Amazon

Address

Phone number

Point of Contact/Website

e.g. https://www.amazon.com/BROADMAN-CHURCH-SUPPLIES-Pre-Filled-Fellowship/dp/B00PUTWIII/ref=redir_mobile_desktop?ie=UTF8&aaxitk=VGECR.hNkZWr.SkNYLWpzA&hsa_cr_id=5587249880201&ref_=sbx_be_s_sparkle_td_asin_0

Tax ID

If Applicable.

Purchase/Reimbursement Request

Items/Services *

Please provide a description, quantity, and total price including tax.
e.g.
1. Communion Elements (250 per case) - 4 Cases $293.03
2. Candles - 4 packs $4.28
3. Lighter - (1) $2.37

Purchase Grand Total *

Please provide grand total amount for check request/PEX purchase by adding all of the totals listed above.
e.g. $299.68

NOTE*** All Funds/Checks Are Subject to Approval.

Special Instructions *

Please respond with the following purchase/reimbursement options.
1. Mail Check to Payee
2. Hand Deliver to: ____________
3. To be picked up by: ______________
4. Please load funds to _______________ PEX Card
5. Other:_______________

Example: Hand Deliver to First Lady Lashawn Thompson

Electronic Signature *

Date *

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