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Expense Account Statement Form

EXPENSE ACCOUNT STATEMENT

Account of :_________________________ (employee name)
From _____________ to ______________

Reimbursable Expenses Incurred

Lodging $_______________________
Meals $_________________________
Travel [air/train/bus/auto] $________________
Personal automobile _____ miles x ___ cents $____________
???????Parking _____ hours x ______ dollars $______

Others (itemize):
________________ $______________
________________ $______________
________________ $______________
________________ $______________
Total: $________________________

Grand Total: $__________________

Select one
[] Credit to account of _____________________
[] Send check to ____________________________

I certify the above is a true statement and that the expenses claimed were incurred by me on official business.? Receipts for each expense are attached.

_______________________________
Employee

Approved for payment:

By:____________________________

Please be aware that these sample letters and forms may have legal and financial implications. Please consult with your own legal advisor if you have any questions or concerns regarding the use of any of these letters and forms.