Expense Reimbursement Form
Once this form is submitted, it will be approved by the Site Director or Executive Director. Reimbursements will be paid on your next available paycheck as a non-taxed reimbursement. Please allow up to 2-3 weeks for reimbursement.
Employee Name
*
First Name
Last Name
Email
*
example@example.com
Business Purpose
*
Site for which purchase was made:
*
Bryant
Laurelhurst
Expense List
*
Purchase Date
Vendor/Store Name
Description
Cost ($)
1
2
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9
10
Total Costs Submitted for Reimbursement
*
Please upload full receipt(s).
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Notes
Employee Signature
*
Submit
FOR OFFICE USE:
Director Signature Approving Reimbursement
Should be Empty: