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: $_________________________
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I certify the above is a true statement of incurred
expenses in accordance with company policy. Receipts are
attached.
_______________________________
Employee
Approved for payment:
By:_____________________________