EXPENSE ACCOUNT STATEMENT
Employee：_________________________________________________________For period ending：________________________________________________
REIMBURSABLE EXPENSES INCURRED
Hotel/Lodging $_________________________
Meals $_________________________
Tax $_________________________
Travel $_________________________
Personal auto _____ miles x ___ cents $_________________________
Parking $_________________________
Phone $_________________________
Other ：
_____________________ $_________________________
_____________________ $_________________________
_____________________ $_________________________
_____________________ $_________________________
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：_____________________________
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