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Excerpt from "Expense Reimbursement Request"

Employees may use this single-sheet form to request reimbursement for both mileage and other expenses. And it's easy to customize.

Expense-reimbursement Form

This form is used to request personal reimbursements only. Use the company's standard purchase-order form for vendor orders. Please call the business office at ???-???? if you have any questions.

Name: _________________________________________ Date: ________________________________

Department: ________________________________ Supervisor: _________________________________

Mileage

Mileage is reimbursed at a per-mile rate determined annually by the IRS. The business office will calculate your reimbursement based on

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