Mozilla Foundation Expense Report

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 3  NAME:          
 4               
 5  MONTH/YR:          
 6               
 7  PROJECT/EVENT: Foundation - General          
 8               
 9               
 10  Expense Form Instructions
 11  Please fill out expense form completely and indicate currency by the total. Each purchase made should go on its own line and all expenses should be in the same currency. For items purchased in another currency, use the above space to indicate the exchange rate you used between the two currencies. For expenses regarding the entertainment of others, describe the reason for the entertainment cost, mention guests and employers, and reference the Item ID # from the table of expenses. Send form and copies of all of your receipts to your manager.
 12               
 13  ITEM # DATE EXPENSE TYPE VENDOR NAME DESCRIPTION CURRENCY AMOUNT US AMOUNT
Accommodations Berghotel Grosse Scheidegg Hotel Stay 54.50 CHF
1 CHF = $1.10
 59.79
 29               
 30          TOTAL  
 31  PAYEE INFORMATION:            
 32               
 33  Payee Contact Information:       Bank Wire Information: (if outside USA)    
 34  Organization     Bank Name  
 35  In care of     Address  
 36  Address1     City, State/Province  
 37  Address2     Postal Code, Country  
 38  City     Account Number  
 39  State/Province     ABA/Routing number  
 40  Postal Code     Swift Code (for International Banks)  
 41  Country     Branch number (for Canadian Banks)  
 42  Telephone     Transit number (for Canadian Banks)  
 43             
 44  Approved By :     Signature:_______________________________________________________________