Expense Account Statement 2

EXPENSE ACCOUNT STATEMENT

Employee:_________________________________________________________
For period ending:________________________________________________

REIMBURSABLE EXPENSES INCURRED

Hotel/Lodging $_________________________
Meals $_________________________
Tax $_________________________
Travel [air, train, bus] $_________________________
Personal auto _____ miles x ___ cents $_________________________
Parking $_________________________
Phone $_________________________
Other [itemize]:
_____________________ $_________________________
_____________________ $_________________________
Total: $_________________________
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I certify the above is a true statement of incurred
expenses in accordance with company policy. Receipts are
attached.

_______________________________
Employee

Approved for payment:

By:_____________________________