- This form is to be submitted by District Managers only.
- Forms submitted by anyone else will not be processed.
- Fill out all applicable fields highlighted in yellow. Incomplete forms will be returned and reimbursement will be delayed.
- Submit one form per employee. Forms with multiple employees will be returned and reimbursement will be delayed.
- Requests for Per Diem/Mileage will be processed once per week by the Finance Department
- Requests must be submitted by Tuesday at 12:00 PM for the previous calendar week
- Requests received after 12 PM Tuesday will be processed the following week.
- Special notes are required for irregular circumstances
Employee Information
Employee name:
Joe Schaeppi
Employee number:
7828
District manager:
Job Site
Store location:
596 - T0803 Des Moines IA
City:
Des Moines
State:
IA
Hotel Info
First night needed
01/02/2024
Last night needed:
01/05/2024
Per Diem
For office use only.
Arrival Date
01/02/2024
Departure Date
01/05/2024
Mileage
For office use only
Date
Departed from
Destination/Store
RT/OW
MI
Amt