Expense Reimbursement FINANCE: Expense Reimbursement I’m filling this out for: * MyselfSomeone Else Submitter Information If you are filling out this form on behalf of another individual please include your information below. First Name * Last Name * Email * Phone * Reimbursee Information Please complete the information for the person receiving the reimbursement. First Name * Last Name * Address * Address This is where the check will be mailed if check is selected. This is where the check will be mailed if check is selected. Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal I prefer to be paid via Check Paypal PayPal ID or E-mail * E-mail * Phone * Activity * Annual Meeting Expenses (March)NATA Travel/Lodging (June)Committee Expense ReimbursementBoard Expense ReimbursementCommittee Day LodgingOther Activity Location * Role * Indicate what role you served or what committee you are representing with your request. (i.e. – Board member, name of committee, Bobby Gunn recipient, etc.) Help us keep our form secure… Type the answer to this math problem: 2+4= * Line Items Please list your expenses by day/date and category. Some receipts may split into more than one category. For travel (airfare, etc.) and lodging, note those expenses on the first and/or last day of the travel dates. CLICK HERE to view the expense categorization to determine the Description option. Reminder: Please don’t submit reimbursement for NATA registration (CE) or liquor/alcohol purchases. Date * Description * Transportation (Air, Rail, Etc.)Local Taxi, Uber, Bus, Etc.ParkingAuto Expenses (not including mileage)LodgingMealsTipsTelephone/InternetMileage Only (see below)Other Description Amount * plus1 Add minus1 Remove Misc Line Items Date Amount Explanation plus1 Add minus1 Remove Mileage Cost Current Rate: $0.70 x mile / Maximum mileage max is $350 Entering mileage only?At least one entry must be made in the Line Items section to submit the form. If you are submitting mileage only, enter one line item by choosing the same date, selecting Mileage Only from the Description drop down menu and entering $0 for the Amount. This is in addition to adding the mileage cost in the above field. File Upload * Drop a file here or click to upload Choose File Maximum file size: 10MB Please include and upload CLEAR images of your receipts or documentation. TOTAL Comments By checking this box, I attest that the above listed expenses were for MAATA related business and I am not recieving reimbursement for the above listed expenses from any other entity. * Agree Submit If you are human, leave this field blank.
