Southern Methodist University

SMU Dedman School of Law

Finance Office

Request for Reimbursement

Individual or Company:

Check Payable to:______SMU ID #______

Address: ______Staff/Faculty & Students

______Zip Code______

Receipt Information:

Date: ______

Place: ______

Total Amount: ______(if you have mileage with this cost include it in this total and attach mileage sheet)

Tape original itemized receipt and credit card receipt to a separate sheet of paper.

Must show proof of payment (credit card receipt, copy of check, email confirmation etc.)

for all items purchased.

Please remember to use your sales tax exemption certificate!

Business Purpose: ______

Attendee’s if any:

SMU staff/faculty:

______

Students/Guest:

______

Account______Fund 10 Org______Subclass______Project______

(4) (2) (6) (5) (7)

Requestor’s Signature______

Reimbursements can take up to 30 days