Employee Reimbursement Form

Please complete the below form for reimbursement of tools or work boots. Once completed, print the form then submit electronically using the submit button. Staple the receipt to the reimbursement form and interoffice to Wendy Bradenburg in Milwaukee for processing.

All approved reimbursements will be made within two weeks of receiving the completed submittal.

Employee Reimbursement Type *

Employee name *

Date of Request * +

Location *

Department *

Purchase Description *

Amount *

Please print the form to allow your managers to approve and sign the reimbursement form. Scroll to the bottom of the form to select "submit" for electronic submittal.

____________________________________

Employee Signature

Date:

____________________________________

Department Manager Approval

Date:

____________________________________

General Manager Approval

Date:

Staple receipt to printed copy and send to Wendy Bradenburg in Milwaukee. Please allow two weeks to receive reimbursement. For questions, contact Wendy at (414) 465-1444. Thank you for submitting!