Example 1
SUMMARY EXPENSE REPORT
To receive reimbursment, please follow the instructions outlined in the reimbursement
\NSGC guidelines. Submissions failing to adhere to these procedures may be delayed in the payout II process.
Mail Form and Receipts To:
Attn: Lisa Crumble
Carthage College
Wisconsin Space Grant Consortium
2001 Alford Park Drive
Kenosha,Wl53140
Contact the WSGC office with any questions.
spacegra nt@ca rthage .ed u
262.551.6054
Rcpt.# Date Vendor/Store
1
2
3
11 /9/16 Google Map
11/9/16 Brit's Pub
11 /9/16 Hyatt Regency
4 11/10/16 Hyatt Regency
5 11 /9/16 Kwik Trip
Please Make Check Payable To:
Name:
Address: Jane Doe 2001 Alford Park Drive
City, State, Zip: Kenosha, Wl53140
Requisitioner:
Jane Doe
Description Amount
Mileage to AISES Conference $ 429.78
Team Dinner $ 133.80
Conference Lodging $ 210.65
Conference Lodging $ 375.94
Fuel for Conference Travel $ 10.80
Total $ 1 160.97
REQUISITIONER STATEMENT: I declare all costs associated with this program are necesary and reasonable for this award,
following all applicable WSGC regulations. The expenses listed on this report were personally incurred.
Date Phone#
Go gle Maps
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via 1-94 W
Example 2
2001 Alford Park Dr, Kenosha, WI 53140 to
2001 Alford Park Dr, Kenosha, WI 53140
Drive 747 miles, 7 7 h 3 min
0
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Map data ©2017 Google
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20mi..__ ____ _
11 h 3 min
11 h 3 min without traffic
741 x $.58 = $429.78
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Example 3
1 , • r
1 ;
',I
I I
0HYATT
REGENCY MINNEAPOLIS
INFORMATION INVOICE
Payee
Confirmation No. 2970196101
Group Name
Date
11-09-1611-09-1611-09-1611-10-16
Guest Signature
Description
Parking Overnight - Self Guest Room Occupancy Tax Visa
I agree that my liability for this bill is not waived and I agree to be held peraonally liable in the event that the indicated person, company or aaaoeiation falls to pay tor any part or the full amount of tneae cnarges.
-------------·· ---
. Hyatt Gold PaaportJ,Ufflll!�JY.
No Membership to be credited
Join Hyatt Gold Passport today and start earning points for stays, dining and more. Visit goldpassport,com
Example 4
Total
Balance
Hyatt Regency Minneapolis 1300 Nicollet Mall Minneapolis, MN 55403 T.1-612-370-1234F.1-612-370-1463www.mjnneapolis hyattcom
Room No.
Arrival
Departure
Page No. 1 of 1
Folio Window 1
Folio No.
Charges
19.00 169.00
22.65
210.65
0.00
Credits
Thank you for choosing the Hyatt Regency Minneapolis. We enjoyed having you as our guest. If, for any reason, we fell short of your expectations we want to know about it. Please call our Quality Assurance Department at 612-596-4685 or send your comments to aualitymsorm@hyattcom. Once again, thank you, we appreciate the opportunity to serve you.
For inquiries concerning your bill please call 405-912-4111.
Please remit payment to: Hyatt Regency Minneapolis PO Box 860122 Minneapolis, MN 55486-0122
INVOICE
Payee
HYATT REGENCY. MIN N: APO:.. IS
2801149501
Example 5 Hyatt Regency Minneapolis@) 1300 Nicollet Mall l J Minneapolis, MN 55403 \. T.1-612-370-1234 F.1-612-370-1463 www . minneapolis. hyatt.com
11-10-16
11-12-16
1 of 1
Folio Window Confirmation No.
Group Name
Booking No.
Am Indian Science & Eng Soc 2016
32GQTLN3
Folio No. 791242
Date
11-10-16 11-10-16 11-10-16 11-11-16 11-11-16 11-12-16
Guest Signature
Description
Parking Overnight - Self Group Room Occupancy Tax Group Room Occupancy Tax Visa
I agree that my llaOIIity for this 0111 is not wa1veo a no 1 agree to be held pe rsonally liable in the event 11a1 I he ind icated person , company or association fails to pay for any parlor the full amount of these charges.
_ttyatt Gold Pa~p_ort Summary
No Membership to be credited
Join Hyatt Gold Passport today and start earning points for stays. dining and more. Visit goldpassport.com
Charges Credits
38.00 149.00 19.97
149.00 19.97
375 .94
Total 375.94
Balance 0.00
Thank you for choosing the Hyatt Regency Minneapolis. We enjoyed having you as our guest. If, for any reason. we fell short of your expectations we want to know about it. Please call our Quality Assurance Department at 612-596-4685 or send your comments to gualitymsorm@hyatt com . Once again. thank you, we appreciate the opportunity to serve you.
For inqu iries concerning your bill please call 405-912-4111 .
Please remit payment to: Hyatt Regency Minneapolis PO Box 860122 Minneapolis, MN 55486-0 122
Example 6 Kt•lik Tt·ip
6 '107 3t-l Ddue(2\
J.teno111onie 0 \H 51f7 5 1
(715) 2:J!> - tl7 ~5
S to,. e II : 6 7,.
CAR \·lA H CODE: Code good at this location only . Please Use l•!ithin 31l Day!: _
OXY87 Pu111p Hul!lbet· Gallons Pdce/Gal Total Fuel
Total Sa Visa Fl
(17
s .1197 $2.119 $10.80
Uisa Fleet xxxxxxxxxx~x?~o~
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