Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Your E-mail Address
Company Location
*
Chinatown Office
Galleria Office
Tatung Office
Expenses List
*
Purchase Date
Store
Product/Service Description
Cost
Business Purpose
1
2
3
4
5
Total Cost:
Upload Your Receipts
*
Browse Files
Cancel
of
Note:
Reimbursement Method
*
CASH
CHECK
I certify
I certify that all information entered above is valid and true.
Submit Form
Should be Empty: