Missing Meal Receipt Form
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1MISSING MEAL RECEIPT FORM
TAPE PARTIAL RECEIPT BELOW
Meal: (Choose 1)
_____ Meal UNDER $10
(ACTUAL COST; NOT a per diem)
_____ Meal OVER $10
Receipt: (Choose 1)
_____ Missing ITEMIZED portion of receipt
_____ Missing PAYMENT portion of receipt
_____ Missing TOTAL receipt
Reason: (Choose 1)
_____ Lost / Misplaced
_____ Restaurant Not Provide
_____ Shared Meal/Another has receipt
(wide usage not recommended)
_____ Other ______________________________
Restaurant: _______________________________
City, St: _________________________________
___________________________________________________
(Day)
(Date)
(Time)
Meal (Bfast-Lunch-Dinner): __________________
Brief Description of Purchase:
________________________________________
________________________________________
________________________________________
Cost:
$ ____________
Tax ______% : $ ____________
Sub Total
$ ____________
Tip ______ % $ ____________
(Max 20%)
TOTAL:
$ ____________
(If exceeds cap, claim cap only $__________)
Payment made by approved traveler: (Choose 1)
_____ Cash ______ Credit/Debit Card
Initial All 3 Lines Below:
_______ No ALCOHOL reimbursement requested.
_______ Items reimbursed for approved traveler
only (not shared with any others.)
_______ Requesting actual expenses incurred.
________________________________________
________________________________________
(Traveler)
(Supervisor or Travel Designee)
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Parent category: Business