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Reimbursement Of Expenses

DATE:

[--- URGENT

DATE REQUIRED:

TIME NEEDED:

CHECK PAYABLE TO: _______________________

AMOUNT OF THE CHECK: $ __________________

REASON FOR PAYMENT: _____________________

JOB NUMBER: ______ CATEGORY: ____________

REQUESTED BY: ___________________________

APPROVED BY: ______________ DATE: ______

TAX I. D. NUMBER (IF APPLICABLE): ______

ATTACH ALL SUPPORTING DOCUMENTS / RECEIPTS