Ageia Travel Request Form Name:
Facility:
Traveling to (facility):
Flying_____
Driving _____
(Check one)
Date Leaving:
am / pm (Circle)
Date Returning:
am / pm (Circle)
Please fax (541-312-0077 Attn: Accounts Payable) travel request form to corporate office for travel arrangements to be made.
*Before the trip that you need arrangements for all employees (directors, and all corporate people) are required to fill out this travel request form. Ageia staff will be doing flight, hotel booking and making other arrangements for you. Confirmations will be emailed to you as they get arranged. *Please, note, Ageia will pay $15 a meal with no more than 10% tip (unless meals are provided by the facility). You must have receipt for reimbursements. Attach the receipts to a manual check request and fax it to Accounts Payable for reimbursements. *Mileage will be paid at $0.48 a mile. Attach the mileage request to the manual check request form and fax to Accounts Payable for reimbursement.
Revised 10/25/2017
