Reimbursement for Vehicle Expenses

In the event that an individual has to pay for gas or service for a state vehicle rather than being able to use the Voyager card, he or she should mail two copies of the ticket to Physical Plant along with the following information:

Date(s) of trip:

Destination:

Reason for trip:

License Plate Number of State Vehicle:

If gas was purchased, show number of gallons:

If other expenses were incurred, please itemize:

Total amount of expenses incurred:

PLEASE SEND REIMBURSEMENT TO:

Name of Individual to be reimbursed:

Address:

Phone:

Division:

Status: (circle one) Faculty, Staff, student, non-student