Exception to Policy Form

EXCEPTION TO POLICY

Travel Number ___________ Traveler's Name ______________________

Date ___________

Destination ___________________ Department __________________________

POLICY EXCEPTION REQUESTED:

________________________________________________________________________________________________________

JUSTIFICATION:

________________________________________________________________________________________________________

I certify that I am not being reimbursed from another source for any portion of the requested payment.

REQUIRED SIGNATURES:

Traveler _______________________ Account Manager _________________________

Please file this form with the reimbursement request.