Reimbursement Form

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					This document provides a comprehensive form for general expense reimbursement.
The employee requesting reimbursement must include a full list of expenses claimed, a
description of expenses, and the amount of expense. The employee must sign the form
before submitting it for approval by a manager. This template document can help a
company track reimbursement requested by, and paid to employees. This document
should be keep by company managers and reimbursements should be properly
recorded and accounted in the company’s books.
                    General Expense Reimbursement Form
Reimbursements from petty cash cannot exceed $50.00. Reimbursements exceeding $50.00 must
be submitted on this form no later than the 3rd week of each month. All requests are processed
the last week of every month. Funds are dispersed the last pay period of each month.

Date Requested:                                            Employee Name:
Employee ID #:                                                    Department:
                                                                        For the Pay Period
Total amount of
reimbursement:                                             Beginning:                        Ending:

                             In stru cti on s f or Comp l eti n g T h i s For m
1.   Enter all of the required information above.
2.   Enter the date that the expenditure occurred below.
3.   Describe the reason and/or purpose for the expense below.
4.   Attach any relevant receipts, credit card statements, etc. to this form.
5.   Sign and date where indicated.
6.   Submit the completed form (with attachments) to your immediate supervisor for review and approval.
              P l e a se n ot e t h a t e v ery f i e l d c o n st i t ut e s r e qu i r e d i nf o r m at i on a n d
                  m u s t b e c o m p l e t e l y f i l l e d i n . I f n ec e ss a ry , at t ac h a d di t i o n al
                  s h e et s . I n c o m pl et e s ub m i t t a l s w i l l be r et u rn e d u n pr o c es s e d.

                              Cost         Date of                                                        Expense
 Type of Expense:                                                      Description of Expense:
                              Code:       Expense:                                                        Amount:




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                General Expense Reimbursement Form

                         Cost         Date of                                                            Expense
 Type of Expense:                                                 Description of Expense:
                         Code:       Expense:                                                            Amount:




                                                                                      Total Expenses $
By signing my name below, I certify that all information contained in this Expense Reimbursement Form
is accurate. I understand that entering false information is grounds for immediate termination of my
employment, and may result in legal action against me.

Employee Signature    Date Submitted        Manager/Supervisor                   Date Approved   Accounting Code




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                      General Expense Reimbursement Form

				
DOCUMENT INFO
Description: This document provides a comprehensive form for general expense reimbursement. The employee requesting reimbursement must include a full list of expenses claimed, a description of expenses, and the amount of expense. The employee must sign the form before submitting it for approval by a manager. This template document can help a company track reimbursement requested by, and paid to employees. This document should be keep by company managers and reimbursements should be properly recorded and accounted in the company’s books.
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