EXPENSE
ACCOUNT STATEMENT
Account of: [r-Name]
From [r-Date] to [s-Date]
Reimbursable
Expenses Incurred
Lodging: $
Meals: $
Travel: $
Automobile: $ Miles:
Gas: $
Meals: $
Travel: $
Automobile: $ Miles:
Gas: $
Parking: $
Others (itemize):
Others (itemize):
Total Itemized:
$
Total plus Reimbursable Expenses: $
I certify the above statement is true and all expenses claimed were incurred by me on official business regarding [s-Description]. Expense receipts are attached. Reimbursement will be paid according to company guidelines.
_______________________________
Employee
Approved for payment:
By:____________________________
Total plus Reimbursable Expenses: $
I certify the above statement is true and all expenses claimed were incurred by me on official business regarding [s-Description]. Expense receipts are attached. Reimbursement will be paid according to company guidelines.
_______________________________
Employee
Approved for payment:
By:____________________________
