Business Expense Reimbursement Request Biomedical Engineering Department Box 7115 NC State University
Date: ___________ Make check payable to: ___________________________________ Address: ________________________________________________________
________________________________________________________________ Employee ID #: ___________________________________________________
Expenses Incurred (attach receipts):
________________________________________________________________ ________________________________________________________________ ________________________________________________________________
Total reimbursement request: $________________
Charge to account: ____________
Object code: _____________
________________________________________________________________ Signature of Claimant ________________________________________________________________ Supervisor’s Approval