ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
2
3
4
Location: Date:
5
CICS Longwood 9-12
6
Employee Name:
7
Standard Mileage (One Way)Winvoice Emails
8
Employee Mailing Address:
Loomis to CICS14pay+cicsloomis@ap-docs.com
9
Longwood to CICS14pay+cicslongwood@ap-docs.com
10
Employee Email AddressLloyd Bond to CICS20pay+cicslloydbond@ap-docs.com
11
Longwood/Loomis to Lloyd Bond9pay+cicsnetwork@ap-docs.com
12
13
AccountDeptFundRestrictionDescription/NotesMiles Rate
Miles ($)
Amount
14
 $ 0.585 $0.00
15
 $ 0.585 $0.00
16
 $ 0.585 $0.00
17
 $ 0.585 $0.00
18
 $ 0.585 $0.00
19
 $ 0.585 $0.00
20
 $ 0.585 $0.00
21
 $ 0.585 $0.00
22
 $ 0.585 $0.00
23
 $ 0.585 $0.00
24
 $ 0.585 $0.00
25
 $ 0.585 $0.00
26
 $ 0.585 $0.00
27
28
Please attach receipts for the expenses requested, and for any mileage expenses outside of the standard mileage provide a map detailing the start and end of your trip with the stated mileage. Once this form has been completed and signed by the correct supervisor, scan/email this form and the support via Winvoice (listed above). Please note that the address listed is where the reiumbursement check will be delivered to. Thank you.
29
30
31
Director Approval Signature:
32
33
34
35
-
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100