Reimbursement Voucher for Westminster College Faculty or Staff Travel (updated 12-2-16)

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* 1. Requester's name ( Last Name, First Name, please.)

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* 2. Today's date

Date / Time

Date

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* 3. Requester's Department

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* 4. Last name of requester's supervisor/division chair

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* 5. Destination City

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* 6. Destination State

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* 7. Destination Country

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* 8. Start date of travel

Date / Time

Date

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* 9. End date of travel

Date / Time

Date

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* 10. PO number generated for this travel.

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* 11. Please enter the account number(s) approved for charges (no spaces, no dashes) and the amount approved for each account. Faculty, note that the account number for Professional Conferences/Papers is 10140124062000.

Account number / Account name / Amount

If any expenses were paid via a Westminster credit card, do not include them on this form, but include a copy of the signed Travel Request and PO to the monthly credit card payment request.

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* 12. Airfare expense (Enter as number only: ex. 178.45. Do not use dollar sign.)

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* 13. Personal auto expense - at 0.51 per mile - (Enter as number only: ex. 178.45. Do not use dollar sign.)

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* 14. If a personal vehicle was used, provide the following details:

Starting location:

Destination:

One-way or roundtrip?

Total Mileage:

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* 15. Rented vehicle expense - cost of rental plus fuel (Enter as number only: ex. 178.45. Do not use dollar sign.)

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* 16. Lodging expense (Enter as number only: ex. 178.45. Do not use dollar sign.)

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* 17. Meals expense (Enter as number only: ex. 178.45. Do not use dollar sign.)

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* 18. Registration and fees expense (Enter as number only: ex. 178.45. Do not use dollar sign.)

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* 19. Miscellaneous (parking, tolls, etc. expense (Enter as number only: ex. 178.45. Do not use dollar sign.)

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* 20. If any personal travel is included in the above expenses, please indicate amount of personal travel.

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* 21. Total amount requested for reimbursement

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* 22. Please enter the account number(s) to use for charges (no spaces, no dashes) and the amount requested for each account. Faculty, note that the account number for Professional Conferences/Papers is 10140124062000.

Account number / Account name / Amount

Signature of Traveler: Electronic submission of this document is accepted as traveler's signature.

Signature of Supervisor/Division Chair: _____________________________________ Date: _______________

Signature of Vice President: ______________________________________________ Date: _______________

Account #: __________________________

Amount Authorized: ___________________________

Account #: __________________________

Amount Authorized: ___________________________

Account #: __________________________

Amount Authorized: ___________________________

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