SBA/Dean's Fund Travel Reimbursement Request
Name of Traveler:
Address:
Phone Number:
SSN or UNM Banner I.D
E-mail
Who is paying for this Expense: Deans Account Student Bar Association
Dates of Travel: (Per Diem reimbursement will be determined from Departure and Return times on airfare Itinerary)
(Please indicate if you are requesting per diem) Yes No
*If you are requesting per diem, please include conference agenda or itinerary
Depart Date: Return Date:
Depart Time: AM / PM Return Time: AM / PM
Destination:
Business Purpose of Travel (Please attach conference agenda or Itinerary if applicable ):
Airline: (Please attach airline ticket / Itinerary)
Airline: Cost of Ticket: $ - Service Fee? $
Paid by? Traveler UNM P-Card
If paid by P-Card: Who is P-Card holder?
Date purchased?
Mileage: Odometer readings - Start Finish
Total Round trip mileage: Cost (x $0.50/mile) $ -
Hotel: (Please attach detailed hotel and/or credit card receipt)
Hotel Name:
How many nights stay?
Per night charges with Tax? $
Registration Fee: (Please attach receipt / confirmation)
Name of Conference / Meeting:
(Please attach conference agenda or Itinerary if applicable)
Cost of Registration Fee: $
Paid by? Traveler UNM P-Card
If paid by P-Card: Who is P-Card holder?
Date purchased?
Does registration fee or conference include meals? Yes No
If so, please indicate which meals (day / meal):
Prepared: 11/12/07 rlj
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Miscellaneous: (Please attach all original receipts)
Were there any other miscellaneous charges? Yes No
Taxi: $ Shuttle: $
Parking: $ Internet $
Other: $ Copies $
Car Rental: Per day rental with taxes? $
# of days rental?
Business Purpose / Reason for need of Rental:
Check list - Are all receipts attached: (Please fill this portion out upon completion of travel)
Airline
Hotel
Conference Fee
Taxi
Car Rental
Parking
Memo - needed for additional explanation / certification of missing receipts, etc.
Request form completed by: Date:
Telephone #:
* Note: Please do not submit your reimbursement paperwork until all the above items have been attached and filled out.
Making sure all items are included will ensure a correct and quick reimbursement or payment
SBA Funds Approved: $
SBA Board Approval: Date:
Dean's Funds Approved: $
Dean's Fund Approval: Date:
Total Amount Approved: $
Prepared: 11/12/07 rlj
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