Employee Reimbursement Form

Date T&E Card
$
$
$
$
$
$
$
$
Carry over to Page 1
Estimated Total
M&I
Mode of Ground Transportation
From To T&E Card
$
$
$
$
$
$
$
$
$
Carry over to Page 1
Estimated Total
Ground Transp
Department:
Date T&E Card
$
$
$
Transfer these totals to Page 1
Estimated Total
Entertainment
empT&E2015 PG2a
Original itemized receipts required for all business entertainment expenses $75 or more. Ref: Appendix A (BUS-79) Per Person Maximums (pg 21)
Personal Funds
$
$
$
Travel Meals & Incidentals Details (G-28)
Business Purpose:
(Required)
Notes
$
$
Personal Funds
List meals & incidentals during travel. Ref: MEALS (G-28) Per Person Maximum
$
$
Number of Participants:
ATTENDEES: (Please attach list if needed)
Business Entertainment Desciption
Type of Expense:
Business Entertainment Reimbursement Details (BUS-79)
$
$
$
$
$
Additional Approval Required-Entertainment? Ref: Additional Approval (Appendix B BUS-79)
Title
$
$
Date Personal Funds
Name
Official Host:
$
$
Affiliation
Comments/Notes:
NOTE: Entertainment expenses require the business purpose, all attendees and job title, and affiliation for reimbursement.
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