Personal Reimbursement Request

This form is used when business expense(s) are paid with a personal card. Submit one form per “event” (e.g. interview, field experiment, lab supply purchase, etc.). Numerous receipts may be included with one Personal Reimbursement Request, so long as all purchasing is for the same event/business purpose.

Indicates required field
$ 
# 
if charging 100% of reimbursement here instead of order to a single speedtype
Is a speedtype split needed?
 
 
Speedtype(s)
Split 1
# 
$ 
Split 2
Split 3
# 
$ 
Split 4
# 
$ 
Split 5
# 
$ 
For each split please provide a speedtype number and $ amount. Contact ebioaccounting@colorado.edu if your purchase involves more than five splits.
Items purchased
Why was this purchase made/how does this purchase benefit the speedtype being charged?
Type of purchase
 
 
 
 
Food Purchased?
 
 
Did this purchase involve food?
If 1-10 attendees, list first and last name and type (student, faculty, staff, business guest, etc.) per person in this field. Or, if 11 or more attendees, indicate the total number of people per category in attendance (e.g. 10 students and 5 faculty/staff). If cost is greater than $500, attach official function form with receipt.
Additional Information
Other pertinent information you would like us to know:
Please ensure that your attached itemized receipt is clearly legible prior to submission. Receipt images must be uploaded as a single document.
One file only.
10 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.