Fillable Travel Reimbursement Request Form The University of Texas (University of Texas at Tyler)

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Travel Reimbursement Request Form The University of Texas (University of Texas at Tyler)

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Travel Reimbursement Request Form
The University of Texas at Tyler
Payee:
RTA #:
UT EID:
Dept.:
Departure
Date/Time:
Return
Date/Time:
Account
Destination
Purpose of Travel: ______________________________________________________________________________________________
______________________________________________________________________________________________
Meals & Lodging
Date Meals Lodging
Daily Total for Meals &
Lodging
(1) Total Meals and Lodging – attach lodging receipts
Transportation Costs
Point-to-Point Itemization Type
(airfare, auto,
bus, taxi)
From To
Personal
Car
Mileage
Mileage
Reimb. @
Fares
Paid
Daily Total for Mileage
& Fares
(1) Total Transportation Costs – attach fare receipts
Incidental Expenses
Description
Amount
(3) Total Incidental Expenses– attach receipts
Total Reimbursement Requested $
Direct Billed Expenses (For Informational Purposes Only):
Airfare $___________
Rental Car $___________
Other Direct Billed Items $___________
I certify that the expense account above is true, correct and unpaid.
Employee Signature Date
Approval Signature Date
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
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Travel Reimbursement Request Form The University of Texas (University of Texas at Tyler)

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Completed 24 July 2020

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