560 Springfield Ave.Suite I
Westfield, NJ 07090
908 233 3443 Fax: 908 233 7644

Statment No:________________

EXPENSE STATMENT

Employee
Name ___________________ Emp# ___________________
SSN ___________________ Position ___________________
Department ___________________ Manager ___________________
Pay Period
From ______________
To ______________
Date Account Description Accom Transport Fuel Meals Phone Entertain Other TOTAL
                     
                      
Approved By
 
Note
 

Reimbursement

Payment Needed
Sub Total  
Substract Advances  
TOTAL  
Office Use Only

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