Engineering Reimbursement Request Form
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1ENGINEERING REIMBURSEMENT REQUEST FORM
DATE:
UCD EMPLOYEE:
Yes
No
EMPLOYEE ID:_________________
MAKE CHECK PAYABLE TO:
NOTE: Employees to make sure they're enrolled to have direct deposit ( )
NAME:
DEPARTMENT:______________
_________
ADDRESS:
DEPARTMENT CONTACT NAME:_______________________
CITY:
CONTACT PHONE NO.:_______________________________
STATE:
ZIP:
CONTACT E-MAIL: ___________________________________
ACCOUNT(S) TO BE CHARGED:
ACCOUNT
AMOUNT
PI APPROVAL:
ACCOUNT MANAGER APPROVAL:
EXPLANATION AND
BUSINESS PURPOSE FOR
ITEMS PURCHASED:
********ORIGINAL RECEIPTS REQUIRED FOR ALL REIMBURSEMENTS********
QUANTITY
ITEM DESCRIPTION
AMOUNT
TOTAL
*****$500 PER DAY MAXIMUM REIMBURSEMENT*****
For office use only: Dafis Doc No. 01-___________________ Date: _________ Initials:________
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Parent category: Business