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: $…………………….
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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:………………………..