CWA Local 3176

Expense Voucher

Entry Type

Hourly Rate $

Enter the hourly rate here ONLY if you are reimbursed for lost wages. Otherwise, leave it blank.

Full Name *

Title *

Enter your union position or type in member if you hold no position.

Phone

Email *

Start Date of Expenses *

End Date of Expenses *

Expense Details

Expense Date *

Reason *

Miles

Meals $

Misc $

Hours

Miles Total $

($.655 per mile)

Other Expenses $

Meals and Misc

Total Wages $

Total Expenses

Additional Notes *

Expense File 1

Expense File 2

Expense File 3

Expense File 4

Signature *

Use your mouse, finger, or touch device to write your signature.

Expense Statement

By signing this form I attest that all information is accurate and all expenses were incurred as a result of union activities.