ACS Reimbursement Request (South Atlantic Conference)

This form will be used to submit reimbursements discussed with the SAC/ACS Director.

BEFORE starting this form please complete a W-9 form if you have not already submitted one to SAC. You may attach the completed form (first page) with your reimbursement request. https://www.irs.gov/pub/irs-pdf/fw9.pdf

AND If you have not already completed the SAC Direct Deposit Form, please do so using this link: https://form.jotform.com/241408508688162

W-9 Form (ONLY REQUIRED FOR WORK PERFORMED, Not Reimbursements)

I will complete and submit a signed W-9 Form to SAC https://www.irs.gov/pub/irs-pdf/fw9.pdf

I have submitted a completed and signed W-9 Form to SAC

Reimbursement Method * Required

I will complete and submit the SAC Direct Deposit Form https://form.jotform.com/241408508688162

I have completed and submitted the SAC Direct Deposit Form

I DO NOT want Direct Deposit

Name * Required

Phone * Required

Email * Required

Address * Required

Church Name * Required

What State Is Your Church Located In? * Required

Reimbursement Reason * Required

Requested Reimbursement Amount * Required

Date Expense Incurred * Required

Enter the oldest date, if there is more than 1 date)

Note

Supporting Documentation * Required

(receipt or Invoice)

Completed & Signed W-9 Form

Additional Supporting Documentation

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