Expense Account Statement Form

EXPENSE ACCOUNT STATEMENT

 

Employee:…………………………………………………

For period ending:…………………………………………

 

REIMBURSABLE EXPENDITURES INCURRED

 

Hotel/Lodging $…………………….

Meals $…………………….

Tax $…………………….

Travel (air, train, bus) $…………………….

Personal auto ….. miles x … cents $…………………….

Parking $…………………….

Phone $…………………….

Other (itemize):

………………… $…………………….

………………… $…………………….

………………… $…………………….

………………… $…………………….

Total: $…………………….

————————-

 

I hereby certify the above is a true statement of incurred expenses in accordance with company policy as per my knowledge. For further reference receipts are attached.

 

 

………………………….

Employee

 

 

Approved for payment:

 

 

By:………………………..

Expense Account Statement Form

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