Reconcile Payment Request If you are human, leave this field blank. Your Name * Email * Area * Reconcile General Year * 2016 2017 2018 Location * London Birmingham UK Wide Europe Request Type * Deposit Payment Request for Funds Invoice Payment Employee_Volunteer Expense Claim Car Mileage Claim REFUND to be made Type of Spend * Catering Cost Consumables (batteries, tapes etc) Design & Production of Media Domain Name Registration & Hosting Marketing Speaker Costs IT Laptop/Desktop IT Other Hardware Merchandise Notes & Teaching Material IT & Software Office Misc Office Phone & Broadband Office Rent Stationery Office Utility Bills (Gas, Elec & Water) Professional Accountant Fees Professional Legal Fees Audit Fees Salaries PAYE Sundry (Miscellaneous costs) Travel Costs Venue & Location Cost Website Development Editing Research/Reading Tutoring Equipment Hire Equipment Purchase Refund - Ticket Refund - Donation Refund - Product or Service Loan Date * This is the date of invoice, deposit, funds required, expenses incurred or Refund to be made. Amount (£) * Enter the total amount as a number. i.e. if £200 or £10.54 then enter 200 or 10.54 respectively with out the '£' sign. Total Invoice Amount (£) * Start Location * Enter the name of the location where you started your Journey Finish Location * Enter the name of the location where you ended your Journey Trip Type * Single Return Car Registration Number * Total Mileage * Enter the total number of miles. The amount (£) to be reimbursed is automatically calculated below based on £0.45p per mile. Petrol Claim Amount (£) * Enter the total amount as a number. i.e. if £200 or £10.54 then enter 200 or 10.54 respectively with out the '£' sign. IF you have claiming mileage, then please do not edit the value that has been calculated automatically based on the number of miles you have entered above. Budgeted * Yes No Attachment * Uploading Files. Please Wait. Drop a file here or click to upload Choose File Maximum upload size: 67.11MB IMPORTANT: Please read below As you have selected DEPOSIT Payment, then you must attach the deposit invoice or any document from the supplier/vendor addressed for the attention of 'Reconcile' that references the deposit you are requesting to be paid. This can be an email or any other type of supporting documentation. You have selected INVOICE Payment and therefore, you must attach the invoice which must be addressed to 'Reconcile' with all relevant information of the payee (supplier/vendor/seller). As you have selected EXPENSE claim then you must attach the receipts. If you have more than one receipt, please zip them into one file and upload the zipped file. Please provide justification for the mileage claim * Method of Initial Payment * Bank Cash Cheque PayPal GoCardless JustGiving Date of Initial Payment * Reference/Transaction ID of Initial Payment * Initial Payment Amount (£) * Customer Name & Bank Details * Enter N/A if intitial payment was made via paypal within 46 days. Additional Information Declaration * I declare that the information provided in this Payment Request form is accurate and costs incurred and stipulated in this request are related to the work of RECONCILE.