Expense Account Statement

Employee: _____________________________

For period ending: ______________________

 

Reimbursement Expense Incurred

 

Hotels/Lodging $_______________

Meals $_______________

Tax $_______________

Travel (air, train, bus) $_______________

Personal auto (y/n)_____miles x_____ $_______________

Parking $_______________

Phone $_______________

Other (itemize):

__________ $__________

__________ $__________

__________ $__________

__________ $__________ $_______________

 

Total $_______________

 

I certify the above is a true statement of incurred expenses in accordance with company policy.  Receipts are attached to this statement.

 

Employee______________________

 

Approved for payment:

By:___________________________

 

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