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Expense Reimbursement Request
Payee Name Expense Period Start Date
Payee Address
City State Zip Expense Period End Date
Payee Signature Date
Business Purpose for Expenses
Expense Date Expense Description Amount
Total Amount:
Office Use Only
Received by: Reimbursement Approved: Yes
Name
No
Signature Date
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The successful man is the one who finds out what is the matter with his business before his competitors do. | Roy L. Smith