Online Expense Envelope Submission

Driver's Name	* required
Corp. Name	*
Leased To	*
For Month Ending	(mm/dd/yyyy) *
Email Address	*
Note: Do not record expenses that are decucted from your settlements. If no item expenses, enter "00".
Personally Paid Items	Amount
#170 Taxes - Personal Estimates:
#205 Taxes - Payroll:
#505 Bank & C.C.I.S. Fees:
#510 Bonds:
#525 Fuel Expenses:
#529 Health Insurance:
#530 Insurance:
#534 Accounting Fees:
#540 Motels and Lodging:
#545 Office Supplies:
#555 Misc Expenses:
#560 Permits and License:
#565 Postage/Courier Fees:
#570 Taxes - Heavy Vehicle Use:
#575 Telephone:
#580 Tire Expense:
#585 Repairs/Parts/Services:
#587 Truck Supplies:
#590 Truck Wash:
#595 Refrigeration Fuel:
#600 Unloading/Lumper:
#605 Weights and Tolls (Full Amount):
Truck Payment:
Trailer Payment:
#535 Meals and Incidental Expenses:
A. If using per diem rate indicate # Days Out:
Other/Comments: