subject_line
Expense Reimbursement Request
Section 1: To be Filled Out by Employee
Date Form is Being Submitted:
*
+
Employee Name
*
Email Address
*
CX ID:
*
Supervisor Name
*
Supervisor Email Address
*
Description of Expenses and Business Purpose:
*
Start Date
*
+
End Date
*
+
Mileage:
Do you have mileage to add?
Yes
No
Trip Details- From, To, & Date Traveled - Trip 1
Budget Code - Trip 1
Miles - Trip 1
Add Trip?
Trip Details- From, To, & Date Traveled - Trip 2
Budget Code - Trip 2
Miles - Trip 2
Add Trip?
Trip Details- From, To, & Date Traveled - Trip 3
Budget Code - Trip 3
Miles - Trip 3
Add Trip?
Trip Details- From, To, & Date Traveled - Trip 4
Budget Code - Trip 4
Miles - Trip 4
Add Trip?
Trip Details- From, To, & Date Traveled - Trip 5
Budget Code - Trip 5
Miles - Trip 5
Add Trip?
Trip Details- From, To, & Date Traveled - Trip 6
Budget Code - Trip 6
Miles - Trip 6
Add Trip?
Trip Details- From, To, & Date Traveled - Trip 7
Budget Code - Trip 7
Miles - Trip 7
Mileage Reimbursement Total:
0.00
Calculate
Receipts/Other Expenses:
Do you have receipts or other expenses to add?
Yes
No
Date1
+
Description1
Category1
Fees
Lodging
Meals
Transportation
Other
Budget Code1
Cost1
Add Receipt?
Date2
+
Description2
Category2
Fees
Lodging
Meals
Transportation
Other
Budget Code2
Cost2
Add Receipt?
Date3
+
Description3
Category3
Fees
Lodging
Meals
Transportation
Other
Budget Code3
Cost3
Add Receipt?
Date4
+
Description4
Category4
Fees
Lodging
Meals
Transportation
Other
Budget Code4
Cost4
Add Receipt?
Date5
+
Description5
Category5
Fees
Lodging
Meals
Transportation
Other
Budget Code5
Cost5
Add Receipt?
Date6
+
Description6
Category6
Fees
Lodging
Meals
Transportation
Other
Budget Code6
Cost6
Add Receipt?
Date7
+
Description7
Category7
Fees
Lodging
Meals
Transportation
Other
Budget Code7
Cost7
Attach Receipts:
Attach Receipts:
Receipts 1
Receipts 2
Receipts Reimbursement Total:
0.00
Calculate
Reimbursement Total:
0.00
Calculate
Ready to submit?
Yep!
Questions about this form? Contact Katey Davis.
Section 2: To be Filled Out by Supervisor
Comments:
Approved
Rejected
Date
+
Ready to submit?
Yep!
Questions about this form? Contact Katey Davis.
Section 3: To be Filled Out by CFO
Comments:
Approved
Rejected
Date
+
Ready to submit?
Yep!
Questions about this form? Contact Katey Davis.