WACUHO - Travel Reimbursement Form.xlsx

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2											Travel Reimbursement Request Form
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5	Requestor Information			Travel Information					Method of Payment		ACH
6	Name			Purpose	Other
7	Address Line 1			Other Purpose					ACH information on file?		No
8	Address Line 2			# Per Diem Days					Bank Name
9	City, State, Zip			Per Diem Allowance					Account Type
10	Email			Per Diem Allowance					Routing Number
11	Phone			Mileage Rate					Account Number
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13			Travel			Per Diem
14	Date	Description	Airfare	Ground Transportation	Miles Driven	Lodging	Meals & Tips	WACUHO Card?	WACUHO Card Amount	Reimbursement Amount	Total
15				$ -		$ -	$ -	No		$ -	$ -
16						$ -	$ -	No		$ -	$ -
17								No		$ -	$ -
18								No		$ -	$ -
19								No		$ -	$ -
20								No		$ -	$ -
21								No		$ -	$ -
22								No		$ -	$ -
23								No		$ -	$ -
24								No		$ -	$ -
25								No		$ -	$ -
26	Total		$ -	$ -	0.0	$ -	$ -		$ -	$ -	$ -
27									Less Amount over Per Diem Allowance	$ -
28	Notes:								Total Reimbursement	$ -
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32							Return this form and all original receipts to:
33	Requestor Signature			Date			phil coontz
34							Once Shields Avenue Davis, CA 95616
35							treasurer@wacuho.org
36	Approval Signature			Date			530-752-1788
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38							Payment can generally be expected within 14 days of receipt of this request by the treasurer.
39	Treasurer/President Approval Signature			Date
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43	Instructions:
44	All required fields are marked by being highlighted in pale red.
45	Complete Requestor Information.
46	Indicate the Purpose of the trip using the dropdown options. Choose "Other" and indicate in the Other Purpose box if none of the options are applicable.
47	Indicate the number of Per Diem days. The number of days for the default options is indicated in parentheses in the Purpose field.
48	Choose the Method of Payment to receive the reimbursement. If choosing ACH, additional fields will be presented.
49	Complete the travel expense detail section. On each line, complete the Date, Description, one of the amount columns (Airfare, Ground Transportation, Miles Driven, Lodging, Meals & Tips), and the WACUHO Card column.
50	Note that Ground Transportation does not include mileage. For mileage reimbursement, indicate the number of miles driven in the Miles Driven column.
51	The WACUHO Card column indicates whether or not the relevant expense was made on the WACUHO credit or debit card. This would have happened in coordination with the treasurer.
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