Payroll Reimbursement Request
Please complete the below fields to request a reimbursement to an upcoming pay period for items you were authorized to purchase on behalf of Mills Park Hotel. Your Manager will review and approve/decline the request and notify you accordingly. Please note, all requests for reimbursement must have an accompanying receipt turned into the Front Desk Office and all reimbursements will be completed on your next payroll cycle.
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Email *
Name *
Enter your first and last name below.
Verify Email *
Verify the e-mail above, a copy of this form will be sent here.
Purchased Items *
List the item(s) and amounts purchased that need reimbursed.
Vendors *
Enter the name of the store(s)/website(s) the items were purchased from.
Total Amount *
Enter the total amount needing reimbursed
Select the payment method(s) used to purchase the item(s) *
This should match the payment method on the receipt turned into the Front Desk Office.
Required
Anticipated Pay Date *
Select the Friday Pay Date you anticipate to be reimbursed for the above amounts. Note - this should be 2 weeks after your last pay check received. You can find that date below and then select the date that is two Fridays later.
MM
/
DD
/
YYYY
Terms and Conditions Confirmation *
By checking the box below, I confirm the following:
  • I have submitted receipt(s) to the Front Desk Office from the stores listed, which match the total amount and payment types stated;
  • Reimbursement will not be provided unless approved by my manager;
  • Reimbursement for the amount listed will be included in my next paycheck;
  • I will not receive a cash or check payment for this reimbursement.
Required
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