Expense Report

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Expense Report

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Employee Name

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Department

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Submission Date

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Expense Items

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#	Date	Description	Category	Merchant	Receipt	Qty	Unit Cost	Total

Mileage

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#	Date	Purpose	From	To	Miles	Rate	Total

Summary by Category

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Category	Amount

Total Amount:

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Reimbursement Details

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Sign-Off

Employee

Signature

Name: {{EMPLOYEE_SIGNER_NAME}}

Date: {{EMPLOYEE_SIGN_DATE}}

Manager Approval

Signature

Name: {{MANAGER_SIGNER_NAME}}

Date: {{MANAGER_SIGN_DATE}}