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Expense Reimbursement
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Name
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Email
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Phone Number
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Client name (N/A if not applicable):
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Your answer
Event name (N/A if not applicable):
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Your answer
Date of Expense
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MM
/
DD
/
YYYY
Reason for Reimbursement (Check All That Apply)
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Fuel
Mileage
Hotel
Meals
Transport
Other (Briefly Describe)
Required
Itemized List - Use the Following Format: $ Amount - Reason
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Your answer
Detailed Description of Expenses Incurred:
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Your answer
Total Reimbursement Amount
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Did You Submit the Receipt(s) For These Purchases?
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Yes
No
NOTE: Failure to Submit Receipts Greatly Reduces the Chances for Reimbursement.
I Understand
I Do NOT Understand
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