AMS Disbursement Request
A. PERSONAL INFORMATION
Name
*
Email
*
Phone
*
Format: 000-000-0000.
Address
*
City
*
State
*
Zip
*
B. EXPENSES
Rows
Date
Items
Purpose
Amount
1.
2.
3.
4.
5.
6
7
Expense Total
Receipts
Browse Files
Drag and drop files here
Choose a file
You must provide receipts for all expenses listed above
Cancel
of
C. MILEAGE
Rows
Date
From/To
Purpose
Miles
1
2
3
4
5
6
7
Total Miles
GSA Rate*
Mileage Total
*
Click Here for current GSA Mileage Rate
D. CASH ADVANCE
Rows
Date Required
Date of Event
Purpose
Amount
1
2
3
For Cash Advances, you must submit an Expense Tracking Form to the AMS Office within 10 days after the event/purpose. Receipts for all expenditures must accomany the form. Any unused funds must be returned to AMS.
E. MAILING INSTRUCTIONS
Total Reimbursement
Total Advance
Payable To:
*
Mail Check To
*
Address listed in Part A above
A Different Address
Alternate Mailing Address
Please sign in the space below
Submit
Should be Empty: