EXPENSE ACCOUNT STATEMENT
Employee:_________________________________________________________
For period ending:________________________________________________
REIMBURSABLE EXPENSES INCURRED
Hotel/Lodging $_________________________
Meals $_________________________
Tax $_________________________
Travel [air, train, bus] $_________________________
Personal auto _____ miles x ___ cents $_________________________
Parking $_________________________
Phone $_________________________
Other [itemize]:
_____________________ $_________________________
_____________________ $_________________________
_____________________ $_________________________
_____________________ $_________________________
Total: $_________________________
-------------------------
I certify the above is a true statement of incurred
expenses in accordance with company policy. Receipts are
attached.
_______________________________
Employee
Approved for payment:
By:_____________________________
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