ACCT # :

TRAVEL EXPENSE CLAIM FORM

(Please submit original receipts and completed form )

Employee Name:

DATE:
CONTACT :
DEPT:

Designation:

Destination:
Address:

Phone:

City, State:

Inclusive Dates of
Travel:

Purpose of Travel

Date

Lodging

Breakfast

Lunch

Dinner

Taxi,
Airfare,
Shuttle,
Incidentals
Train, etc. Parking,
Car Rental

Private Auto
Miles

Rate

Amount

Reg. Fees
& Other
Business
Expenses

Total

( Please use a separate page if more spaces are needed.)

Notes:

Total Amount Expended

Less Amount Advanced
Due Amount

AMOUNT DUE TO EMPLOYEE

I hereby certify that the above is a true statement of the travel expenses for the authorized travel.
____________________________________________

Signature of Traveler/Date

______________________________________________

Account Authorized Signature/Date

Ganesh IT Solutions Accounting Use Only

Date

Approval:

Expense Amount

Date: