Expense Reimbursement Form - Excel

					                                                                                                                                     Please Check Appropriate Box:
                                                                                                                                        Reimbursement
   Input only in                                                                                                                        Advance
  shaded areas                        (Please Type or Print)                   EXPENSE REIMBURSEMENT FORM                            Please Note: Incomplete information may
             NAME:                                                                                                                                      result in a reimbursement delay.
       ADDRESS:                                                                                                                     (Dept/Project #:)        (Department or Project Name:)
          APU ID #:                                                                         Phone # or Ext:
   1           2                                                          3                                                4               5              6                                7
# Recpt                  List place & purpose of expense & attach orig. receipt:             (hosting of others must     Amount            Personal Auto Use            Chartfield String to Charge
              Date
or None                  incld names & purpose on form/recpt or separate sheet) <THIS IS AN IRS REQUIREMENT>           (Non Auto)        Miles Reimburse / mile
                                                                                                                                                     @$0.50             Fd Dept Acct Proj(Pxxxxx)
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TOTALS                                                                                                                       0.00                                0.00
Requires Original Signatures                        (Please print names as well)
       Submitted By:                                                                                  Date:                          Total of all Expenses                                               0.00
                         PRINT NAME                           SIGNATURE
          Supervisor's                                                                                                               Less Advances - Enter as + amount
             Approval                                                                                 Date:                          Reimbursable Amount                                                 0.00
                         PRINT NAME                           SIGNATURE
           Bus. Office                                                                                                               Amount to Donate** (Check Box Below)
             Approval                                                                                 Date:                          Total Reimbursemt or <Advance $ to be Return'd>                     0.00
                                                                                                                                                **      Donate to APU Scholarship Fund
Original Receipts Must Be Attached                                            Tax Documented (For Business Office Use Only)                     **      Donate to Restricted Acct #:

                                                                                                                                                                                       Revised Date: 10-06-2010

				
DOCUMENT INFO
Description: Expense Reimbursement Form document sample