SEND COMPLETED FORM TO: ACCOUNTS PAYABLE VIA INTEROFFICE MAIL EMPLOYEE REIMBURSEMNT POLICY JP06.1- CURRENT VERSION OF THIS POLICY MAY BE VIEWED AND DOWNLOADED FROM THE MONTEFIORE INTRANET The expense being claimed for reimbursement must be reasonable, directly connected with, and necessary or appropriate in pursuit of the Montefiore. An original receipt must support each expense regardless of dollar amount. All checks for reimbursement will be mailed directly to the employee’s home. The Accounts Payable Department will process and mail checks within 14 days of receipt providing all documentation, approvals and related explanations are properly completed. EMPLOYEE MUST SIGN REIMBURSEMENT All Employee Reimbursement require two signatures. The following amounts require additional signatures as follows: Over $10,000 - Vice President Signature. Over $100,000 -Senior Vice President Signature. Over $1,000,000 -Executive Vice President Signature. For Conference expense, reference each day spend (Ex. Date 1, Date 2, Date 3)
DATE PREPARED
EMPLOYEE NAME*
TITLE*
EMPLOYEE HOME ADDRESS*
APT #
CITY*
STATE*
ZIP CODE*
MONTEFIORE DEPARTMENT*
TELEPHONE*
Employee ID#*

EXPLANATION OF BUSINESS PURPOSE FOR DAY(S): PAGE OF IF MORE THAN ONE PAGE

	Company Code	ACCOUNTS TO BE CHARGED DIV. ACCT. NO. OR SPEC. FUNDING NO. & EXP. CODE
		6022000
		6022005
		6022015
		6022020
		6022030
		6022050
		6022060

	MINUS TOTAL ADVANCES
Total of Check

Complete Only if Requires Notification of Payment
Montefiore Department
Telephone
Location