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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:

				
DOCUMENT INFO
Description: This Expense Reimbursement Form sets forth a template worksheet for an employee to record out-of-pocket expenses for which the employee is seeking reimbursement from the employer. The employee should list the date, description, type, and amount of the expenses paid. The employee must also attached receipts to the report. Businesses seeking to provide a formalized process for employee reimbursement should use this Expense Reimbursement Form to document business related expenses paid by employees.
This document is also part of a package HR Forms for your Business 108 Documents Included