General Reimbursement Form

Transcript

General Reimbursement Form Name: Print this page Department: Home Address: SSN: EMPLID: City: State: Phone: Zip Code: Travel Section Conference Title/Purpose Conference Location Travel Dates From Account Fund Deptid Program To Class Proj/Grant Travel Chartfields: Registration Fee Chartfields: 555190 Entertainment Chartfields: 553500 Dates: Totals Registration fee: Airfare/Rail: Car Rental: Taxi/Bus/Limo: Parking/Tolls: Hotel/Lodging: Breakfast*: Lunch*: Dinner*: Entertainment***: Mileage**: Check calendar year for reported mileage: 0.00 CY 2013 CY 2014 Departmental Deduction Travel subtotal: Deduction Reason: *Complete Entertainment Expense Details section, below, if applicable. 0.00 0.00 Total Travel Reimbursement: ** Enter number of miles. *** Entertainment Expense Details section, below, must be completed. 0.00 General Reimbursement Form Name: Print this page Department: Home Address: SSN: EMPLID: City: State: Zip Code: Phone: General Reimbursement Section Expense/Business Purpose: Account Fund Deptid Program Class Proj/Grant Account Fund Deptid Program Class Proj/Grant Account Fund Deptid Program Class Proj/Grant Account Fund Deptid Program Class Proj/Grant Account Fund Deptid Program Class Proj/Grant Expense/Business Purpose: Expense/Business Purpose: Expense/Business Purpose: Expense/Business Purpose: Total General Reimbursement: Print this page General Reimbursement Form Name: Department: Home Address: SSN: EMPLID: City: State: Zip Code: Phone: Signature Page Total Reimbursement: 0.00 Note: If you are an employee interested in receiving your reimbursement through direct deposit, sign up for ACH reimbursements in Campus Connection by visiting the Employee Reimbursement page. Employee's Name (print): Date: Employee's Signature: Budget Manager's Name (print): Date: Budget Manager Signature: Employee's Manager's Name (print): Date: Employee's Manager Signature: Print Options Print Travel Section and Signature Page For Accounts Payable use only: travel section totals Travel Chartfields: Account Fund Deptid Program Class Proj/Grant Print Travel and Entertainment Details Sections and Signature Page Totals 0.00 Registration Fee 555190Reimbursement and Entertainment Details Sections and Signature Page Print General Chartfields: Entertainment Chartfields: 553500 Print General Reimbursement Section and Signature Page Travel subtotal: 0.00 Print Travel and General Reimbursement Sections and Signature Page Departmental Deduction: 0.00 Travel Travel Reimbursement: 0.00 Print entire form General Reimbursement Form - Print this page Entertainment Details Section Name: Department: Home Address: City: EMPLID: State: Zip Code: SSN: Phone: Note: IRS regulations require a detailed description of the event and business purpose, along with the names, titles and organizational affiliation of each attendee for all entertainment and meal expenses. This information supplements the amounts entered above. All fields are required. Date: Description: Business Purpose: Name Title Organizational Affiliation Title Organizational Affiliation Date: Description: Business Purpose: Name General Reimbursement Form - Print this page Entertainment Details Section continued Name: Department: Home Address: City: EMPLID: State: Zip Code: Phone: Date: Description: Business Purpose: Name Title Organizational Affiliation Title Organizational Affiliation Date: Description: Business Purpose: Name SSN: General Reimbursement Form - Print this page Entertainment Details Section continued Name: Department: Home Address: City: EMPLID: State: Zip Code: Phone: Date: Description: Business Purpose: Name Title Organizational Affiliation Title Organizational Affiliation Date: Description: Business Purpose: Name SSN: General Reimbursement Form - Print this page Entertainment Details Section continued Name: Department: Home Address: City: EMPLID: State: Zip Code: Phone: Date: Description: Business Purpose: Name Title Organizational Affiliation SSN: