Travel and Miscellaneous Expense Report     Name:                                                      

Purpose of Trip:                                                                                                                                                              
                                                                                                                                                                                    
Dates and Details of Trip:                                                                                                                                                 
                                                                                                                                                                                    

                      Travel Costs                    Lodging             Meals                
                                                                                       Supplies/Other           
           No. of       Mileage           Air            Ground      Hotel         Telephone      No.       Amounts         (Describe Below)       Totals
    Date       Miles        Reimb.     Parking     Travel         (Car/Taxi)























  Totals


                                                                               Gross Amount                             
                                                                                                    
                                                                               Less Advance                             
                                      Signature:               Date:               
                                                                               Net Amount Due                            
                                      Approved by:             Date:           
                                                                                     
                                      Reviewed by:             Date:                                
                                                                                          Employee
                                                                                          Company (Attach Remittance)