Receipt Submission
Use this form to turn in receipts from company cards. Use Paylocity if you need reimbursement for an expense you incurred personally.
Name
*
First Name
Last Name
Email
*
example@example.com
Expense Class
*
Houston1
Humble
Spring
Tomball
Resale Shop
Shelter Intervention
Shared Ops
Adoption & Sanctuary
Administrative
Card Type
*
Please Select
American Express - Graphite
Capital One MasterCard
Citi Visa
Vendor
*
Date of the Receipt
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Amount
*
Did you tax exempt this transaction?
*
Please Select
Yes
No
If you did not tax exempt this transaction, please request a refund for the sales tax.
Expense Type
*
Business Meals
Medical Supplies
Cleaning Supplies
Consumables
Postage
Office Supplies
Computer Equipment
Repairs & Maintenance
Medical Equipment Maintenance
Permits & Licenses
Employee Education
Gas & Fuel
Lodging
Dues & Subscriptions
Trade Show Admission Fee
Emergency Services
Notes
Please upload a copy of the receipt.
*
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