Business Expense Form
Employee Name: ______________________________________________________
Expense Date Ranges: _______________ through _______________
| Date | Amount | Category | Mileage | Explanation |
| 1/1/0000 | 45 x IRS Standard Reimbursement | Mileage | 45 | Drove to airport |
| 1/2/0000 | $400 | Air travel | n/a | Flew to LA |
| 1/3/0000 | $55.00 | Meals | n/a | Dinner |
| 1/5/0000 | $750.00 | Hotel | n/a | 3 nights stay |
Please attach all receipts and documentation.
Employee Signature: _____________________________________________
Supervisor Signature: _____________________________________________
Date Filed: _____________________________________________