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receipt-money
Employee Reimbursement
Approved purchases
12
Questions
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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
1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
5
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
6
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
7
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
8
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
9
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
10
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
1
2
3
4
5
6
7
8
9
10
Item Description
Row 0, Column 0
Project
Row 0, Column 1
Cost
Row 0, Column 2
Item Description
Row 1, Column 0
Project
Row 1, Column 1
Cost
Row 1, Column 2
Item Description
Row 2, Column 0
Project
Row 2, Column 1
Cost
Row 2, Column 2
Item Description
Row 3, Column 0
Project
Row 3, Column 1
Cost
Row 3, Column 2
Item Description
Row 4, Column 0
Project
Row 4, Column 1
Cost
Row 4, Column 2
Item Description
Row 5, Column 0
Project
Row 5, Column 1
Cost
Row 5, Column 2
Item Description
Row 6, Column 0
Project
Row 6, Column 1
Cost
Row 6, Column 2
Item Description
Row 7, Column 0
Project
Row 7, Column 1
Cost
Row 7, Column 2
Item Description
Row 8, Column 0
Project
Row 8, Column 1
Cost
Row 8, Column 2
Item Description
Row 9, Column 0
Project
Row 9, Column 1
Cost
Row 9, Column 2
1
of 10
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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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