Travel Expense Reimbursement Form

This form, including necessary approvals, must be completed prior to travel.
Date of Travel

MonthDayYear
Date
Name of Employee
Departure Date

MonthDayYear
Date
Return Date

MonthDayYear
Date
Destination
Purpose of Trip
Account to be paid from
Account Number
DATE OF CLAIM

MonthDayYear
Date
Make check payable, if other than traveler, to:
Detailed Estimation of Travel Expenses
Estimated quantity of cost of airfare (coach class)
Estimated cost of airfare (coach class)
Estimated extended cost of airfare (coach class)
Estimated quantity of personal car expense
Estimated cost of personal car expense (.0625 cents per mile)
Estimated extended cost of personal car expense (.0625 cents per mile)
Estimated quantity of personal car expense
Estimated cost of rental car
Estimated extended cost of rental car
Estimated quantity of taxi, limousine, etc.
Estimated cost of taxi, limousine, etc.
Estimated extended cost of taxi, limousine, etc.
Estimated lodging (number of nights)
Estimated cost of lodging
Estimated extended cost of lodging
Estimated quantity of meals
Estimated cost of meals
Estimated extended cost of meals
Estimated quantity of tolls and parking
Estimated cost for tolls and parking
Estimated extended cost for tolls and parking
Estimated quantity for tips
Estimated cost for tips
Estimated extended cost for tips
Estimated quantity for registration fee
Estimated cost for registration fee
Estimated extended cost for registration fee
Estimated quantity for membership fee
Estimated cost for membership fee
Estimated extended cost for membership fee
Estimated quantity for other expenses
Estimated cost for other expenses
Estimated extended cost for other expenses
ESTIMATED TOTAL TRAVEL EXPENDITURES
1 Signature of Traveler

Clear
Date

MonthDayYear
Date
Work Site
Should be Empty:

Detailed Estimation of Travel Expenses