Expense Account Statement Form

Question

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:                                              $_
-------------------------


     I certify the above is a true statement of incurred
expenses in accordance with company policy.  Receipts are
attached.

_______________________________
                                                Employee

Approved for payment:

By:_____________________________