Expense Reimbursement Form

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Expense Reimbursement Form                                                       Name:

                                                                                 Date:



                                    DATE        DATE        DATE        DATE        DATE        DATE        DATE

               ITEM               ___/___/___ ___/___/___ ___/___/___ ___/___/___ ___/___/___ ___/___/___ ___/___/___    TOTAL

Breakfast

Lunch

Dinner

Tips (Not Included with Meal)

Snacks

Airfare

Lodging

Telephone

Cellular Telephone

Car, Rental, Taxi, Bus, Shuttle

Parking, Towing, Tolls

Postage

Supplies / Copies
Other

Total Miles
Total Mileage $.34 for 2003

Daily Total:

                                                                                                             TOTAL
ENTERTAINMENT EXPENSE

DATE          WHO                            PLACE                               BUSINESS                               AMOUNT




                                                                                                             TOTAL
OTHER EXPENSES

DATE          DESCRIPTION                                                                                               AMOUNT




                                                                                                             TOTAL
EMPLOYEE SIGNATURE:                                                   TOTAL FROM ABOVE                             $

                                                                      TOTAL FROM ADDITIONAL PAGES                  $

APPROVED BY:                                                          COMPANY CREDIT CARD CHARGES                  $

                                                                      TOTAL DUE EMPLOYEE                           $

   NOTE: RECEIPTS MUST BE ATTACHED TO REPORT                          ONE FORM FOR EACH CITY

              CIRCLE ALL COMPANY CREDIT CARD CHARGES WHEN RECORDING ABOVE

                                                                                                                     (Revised 06/03)
      -           -                -         -            -            -
                                             -              -           -                -         -            -            -
                                             -              -           -                -         -            -            -
                                             -              -           -                -         -            -            -
TOTAL                                        -              -           -                          -            -            -

 Employee                                                                     Date Submitted:

 Authorized Signature                                                         Date Approved:
EXPENSE REPORT

[Company Name]                       Employee Name:                                         From:        [mm-dd-yy]
[Street Address]                     Employee ID:                                           To:          [mm-dd-yy]
[City & State/ Province, Zip Code]   Supervisor Name:                                       Pages:
[Phone Number]                       Department:                                            Mileage Rate Per Mile:       $       0.55
                                                    Hotel &                  Personal Car
Date        Description              Meals                       Other                    Miles Cost     Sales Tax       TOTAL
                                                    Travel Costs             Miles
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
                                             -               -           -              -            -           -               -
TOTAL                                $       -      $       -    $       -                  $        -   $           -   $        -

 Employee                                                                     Date Submitted:

 Authorized Signature                                                         Date Approved:
EXPENSE REPORT

[Company Name]                       Employee Name:                                        From:       [mm-dd-yy]
[Street Address]                     Employee ID:                                          To:         [mm-dd-yy]
[City & State/ Province, Zip Code]   Supervisor Name:                                      Pages:
[Phone Number]                       Department:
                                                    Hotel &                                Exchange    Expense
Date       Description               Meals                       Phone       Other/ Misc                            TOTAL
                                                    Travel Costs                           Rate        Currency
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
                                             -               -           -           -            1.00                      -
TOTAL                                        -               -           -           -                                      -

 Employee                                                                     Date Submitted:

 Authorized Signature                                                         Date Approved:
								
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