Total Expense

Report: $0.00
Assessor Expense Report
Name of Assessor:
Game Number: Game Number:

Date of Game: Date of Game:

Home / Away Teams: Home / Away Teams:

Game fee / See chart below: Game fee / See chart below:

Mileage / See chart below: Mileage / See chart below:

Hotel: Hotel:

Miscellaneous / Specify in line below and include receipts: Miscellaneous / Specify in line below and include receipts:

Total Due for Game Number: $0.00 Total Due for Game Number: $0.00
Game Fees: Mileage Reimbursemt Rates per Assessment
International $165 1-99 Round trip miles $0
NWSL - In Stadium $165 100-150 Round trip miles $25
NWSL - Video $150 151-200 Round trip miles $50
Open Cup $150 201-300 Round trip miles $75
National $125 301 + Round trip miles $100
MLS Preseason $125
NASL $120
USL Pro $120
MLS Reserve League $120
*Please type your information into the highlighted sections only.
*Legible copies of all receipts are required where applicable and must be included with this expense report; please write the corresponding game number on each receipt.
*Failure to properly complete an expense report properly, along with illegible / missing receipts will delay payment and/or expenses NOT being reimbursed.
*This form and all applicable receipts MUST be submitted within two (2) business days of the end of each period; the periods each month are the 1-15 and 16-30/31.
*If you work one or two games within a period, please submit only ONE expense report. If you work more than two games in a period, please submit additional expense reports as needed.
*PLEASE DO NOT COMBINE MONTHS.
Please email expense reports to: johnloderexpense@proreferees.com