SAMPLE - 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: $_________________________
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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:_____________________________