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Reimbursement / Check Request
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Temple Aliyah
Reimbursement or Check Request Form
*
Submitter First Name
*
Submitter Last Name
Member Reimbursement
Employee Reimbursement
Vendor Check Request
*
Submitter Email
Payment will be made to the Submitter unless "Vendor Check Request" is marked above. For Vendor Check Requests, be sure to complete the Recipient name and address fields below.
*
Amount Requested:
*
Account Number
This field is required for each expense item. If you do not know the correct account for this expense item, please download the Chart of Accounts
here
or contact Melissa Rudman (
melissa@templealiyah.com
).
*
Describe the purpose of the funds
Amount Requested
Account Number
This field is required for each expense item. If you do not know the correct account for this expense item, please download the Chart of Accounts
here
or contact Melissa Rudman (
melissa@templealiyah.com
).
Describe the purpose of the funds
Reimbursement checks for Temple Aliyah members will be available for pick up in the Temple Aliyah office. Reimbursements for employees will be processed through payroll.
For a check request for a vendor, please provide the recipient's name and address below and a check will be mailed to that address. If you prefer to pick up the check for the vendor, please note this in the special instructions below (no address is required).
Recipient Name
Address Line 1
Address Line 2
City
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Special instructions
Signature
Signature of Committee Chair/Officer
Please attach any receipts or email receipts to elisa@templealiyah.com. Receipts are required for all expenses unless an exception is authorized by Melissa Rudman.
Official Use: Processing date
Friday, February 7 2025 9 Shevat 5785