Expense Account Statement

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:_____________________________