Cleaning Services Reimbursement Form
This form is designed for employees to request reimbursement for cleaning services incurred. Please fill out all sections accurately and provide the required documentation for each service claim. Submit the completed form to the Finance Department via [Your Company Email] by the end of the month for processing.
Section 1: Employee Information
This section collects basic information about the employee requesting reimbursement. Please provide your full name, job title, department, and contact information. This will help us to process your request swiftly and accurately.
Employee Name | [Your Name] |
Job Title | |
Department | |
Contact Number | |
Email Address | |
Section 2: Cleaning Service Details
In this section, describe the cleaning service for which you are seeking reimbursement. Include the service provider's name, service date, and a brief description of the service provided. This information is crucial for verifying the eligibility of your reimbursement request.
Service Provider | [Service Provider Name] |
Service Date | [MM-DD-YYYY] |
Description of Service | |
Section 3: Expense Details
Detail the expenses incurred for the cleaning service here. Please provide the total cost and attach all relevant receipts or invoices as proof of payment. This documentation is essential for the reimbursement process.
Total Cost | [Total Cost] |
Receipt/Invoice Attached | Yes / No |
Section 4: Payment Information
For the reimbursement to be processed, we need your bank account information. Please fill out the details below. Rest assured, your information will be handled with the utmost confidentiality and security.
Bank Name | [Your Bank Name] |
Account Holder | |
Account Number | |
Routing Number | |
Section 5: Approval and Declaration
This final section is for the authorization of your reimbursement claim. By signing, you declare that the information provided is accurate and the incurred expenses were necessary. Your supervisor's approval is also required to complete the process.
Employee Signature
[Your Name]
Date: [MM-DD-YYYY]
Supervisor's Signature
[Supervisor's Name]
Date: [MM-DD-YYYY]
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