Extended Travel Request Form

for travel 30 days or more

"Print this Form" button below which will print this page. Please

Employee Name:		Employee Number:
Email Address:		Travel Authorization Log #:
I will be on extended travel for the period to .
During this time I authorize Reimbursement Services (RS) to make payments to my Visa account for charge incurred during the above travel dates. I understand WHOI will pay charges incurred during the above travel dates. I understand WHOI will pay charges as deemed necessary by JP Morgan Chase and that my account must be current before I depart. I further agree to process appropriate documentation for any payments made on my behalf within 60 days of my return. If I fail to do so, I authorize WHOI to deduct any unpaid portion from my salary or fellowship.

Requisitioner's signature: ____________________________________________ Date: _____/_____/_____

Cost Ctr./Dept
Admin Signature: ___________________________________________________ Date: _____/_____/_____

MS#1 • Woods Hole, MA 02543 • 508.289.2485 • Fax 508.457.2192

Last updated: April 1, 2013