Check Request Form

Please attach any receipts for this check request at the bottom of this form. You can upload a picture to this form or attach most files. If you have questions, don't hesitate to get in touch with the Church Office.

Your Name

First Name

Last Name

Payee

Who should we write the check to?

Payee Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Approver Name

First Name

Last Name

Approval Date

YYYY

Amount to be Paid

Account Name and/or Number

Notes or Instructions for the Bookkeeper

Check Request Form

5220 Silas Creek Parkway

Winston-Salem, NC 27106

(336) 765-6211

epiphanystaff@epiphanyws.org

Worship in Person or Livestream Sundays @ 10:00 am | Encounter Faith: Sundays @ 9:00 am