TRAVEL & EXPENSE REIMBURSEMENT FORM

Instructions:

  • We will no longer be accepting paper travel reimbursement forms.
  • Travel is reimbursed for .52 per mile (2017) and must be preauthorized by your supervisor.
  • Reimbursements will be made within seven days of submission.
  • Reimbursements will be made by electronically issued check from Bangor Savings.
  • You may put round trips on one line but please indicate.
  • Remember not to claim this as a tax deduction as you have been reimbursed.
  • Travel to a different program directly from your home is NOT ELIGIBLE for reimbursement unless it is over 55 miles one way. It is considered a normal commute.
Date
From
To
Purpose
Mileage

Total Miles:

Total Mileage Expenses:

Other Expenses>

Note: Receipts must be submitted to receive reimbursement. Please give administrative person at your site the original receipt after you have submitted it electronically.
Please Itemize Each Expense on a Separate Line
Attach receipt(s)- Multi File uploader
Please Enter Total of Attached Receipts

Total Expenses: