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Example of Expense Reimbursement Form

Example Expense Reimbursement Form

Employee Name/ID  
Reimbursement Dates  

Reason for Reimbursement

Date Item Description Expense Category Cost
Mileage reimbursement for personal vehicles = $0.00/mile SUBTOTAL 0
    TOTAL 0

Employee Signature ______________________________ Date_________________
Manager Signature ______________________________ Date_________________
Do not forget to include all receipts!

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Download Example Expense Reimbursement Excel Template