Expense Report Form
Please use this form to submit reimbursement requests for general expenses and mileage. Note that you will be required to upload images of your receipts as well as odometer readings. One one form you can submit up to one general expense and one mileage date. If you have additional expenses or additional mileage dates, please submit a new form for each.
Name
*
First Name
Last Name
Choose all expense types that you are submitting with this form:
*
Mileage
General (ice, orange juice, etc)
Is this expense for Evans Orchard?
*
Yes
No
Mileage Reimbursement
You are eligible to receive mileage reimbursement for travel to and from an event when we ask you to haul equipment in your own vehicle. Driving to an event that is already set up is not eligible for reimbursement. The reimbursement rate is $0.655 per mile, which is the USG rate. Please upload photos of your odometer showing the starting and ending mileage.
Date Mileage Was Incurred
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Month
-
Day
Year
Date
Event Name
Starting Mileage
Ending Mileage
Total Mileage
This field autopopulates.
Total Mileage Reimbursement Amount
This field autopopulates. Total mileage x $0.655.
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General Expense Reimbursement
Please describe the expense and upload a copy of the receipt. Expenses without a receipt are not eligible for reimbursement.
Date of Event
-
Month
-
Day
Year
Date
In 1-2 words, describe your expense:
Example: ice, OJ, gas
General Expense Amount:
Please upload a copy of your receipt.
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SUMMARY: The total reimbursement requested for this submission:
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