Cell Phone Request and
Justification of Business Usage
Name: __________________________________________ SUID:_________________________
Title: ____________________________________________ Pay Type: Monthly Bi-weekly
Index: __________ Fund:__________ Org:_________ Acct:__________ Prog:________ Activity:________
One-time equipment _______ Monthly allowance: ________OR Full payment on University bill? Yes No
Cell Phone Number: ______________________ Effective Date: _________________
Generally, approved allowances are $40/$60/$80 per month depending upon the level of service determined by
the Dean/VP. Amounts lower than the above may be requested as well.
Recent IRS regulation changes may allow for the tax free treatment of cell phone reimbursements if certain
business reasons are documented. The type of cell phone coverage must be reasonably and necessarily related to
the University’s business needs and the amounts reimbursed must be considered reasonable. Please check the
applicable box(es) below and provide a brief explanation of the reason:
Yes No Does your job function require that you be available to the University at all times for
work-related emergencies?
Yes No Does your job function necessitate that you speak with clients at times when you are
away from the office or outside the normal work schedule (i.e., clients are in different
time zones)?
Yes No Other business reason that may necessitate use of cell phone, (describe below):
Describe the activity that necessitates your use of a cell phone for business purposes:
By signing below, the employee and direct supervisor certify the business need and that they have read
understood and intend to comply with the Samford University Cell Phone Usage and Allowance Policy.
Employee Signature Date
Supervisor/Dean Signature Date
Vice President/EVP Signature Date
Oversight Committee Signature Date
IMPORTANT: Return this form to the Accounting Office-Samford Hall Room 205. For employees receiving
an allowance, please attach a copy of your most recent monthly bill to verify your actual costs exceed the
reimbursement amount.
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