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receipt-money
Employee Reimbursement
Approved purchases
12
Questions
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receipt-money
1
Employee Name
*
This field is required.
First Name
Last Name
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2
Date of Purchase
*
This field is required.
-
Date
Year
Month
Day
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3
Purchased From
*
This field is required.
Vendor or company the items were purchased from
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4
Purchases on this Receipt
*
This field is required.
Item Description
Project
Cost
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5
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7
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9
10
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10
Item Description
Project
Cost
Item Description
Project
Cost
Item Description
Project
Cost
Item Description
Project
Cost
Item Description
Project
Cost
Item Description
Project
Cost
Item Description
Project
Cost
Item Description
Project
Cost
Item Description
Project
Cost
Item Description
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Cost
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5
Sales Tax Total for Receipt
*
This field is required.
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6
Receipt Total - *Verify that it matches the receipt*
$
DO NOT CHANGE - Auto-calculated based on items and sales tax you already filled in
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7
Was the purchase for gas?
No - The purchase was not for gas
Yes - Blue 2016 Ford F-150
Yes - Gray 2020 Ford Ranger
Yes - White 2020 Ford Ranger
Yes - Black 2019 Ford F-150
Yes - Other vehicle *must be indicated in item description*
No - The purchase was not for gas
Yes - Blue 2016 Ford F-150
Yes - Gray 2020 Ford Ranger
Yes - White 2020 Ford Ranger
Yes - Black 2019 Ford F-150
Yes - Other vehicle *must be indicated in item description*
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8
Purchase Categories - Select ALL that apply
*
This field is required.
Auto - Fuel
Auto - Maintenance
Office Supplies
Office Furniture & Computers
Building/Apartment Maintenance Supplies
Tools & Equipment Purchase
Equipment Rental
Food
Inventory/Supplies for Customer Projects
Marketing/Advertising
Software
Other - See item description
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9
I certify
*
This field is required.
I certify that all information entered above is valid and true.
I certify that the total on the receipt matches the total calculated in this form.
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10
Upload Receipt Here
*
This field is required.
Drag and drop files here
Select files to upload
Max. file size
: 15.5MB
Browse Files
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11
Please verify that you are human
*
This field is required.
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12
Signature
*
This field is required.
Clear
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