Events-Refreshment Payment Form

Refreshment break expenses are payable if the criteria listed below is met. In order to satisfy the “Headquarters City” requirements, you must be able to check one box in each of the four categories. A printed, completed copy of this form and the required documentation should be attached to your payment mechanism (e.g., e‑Reimbursement, Purchasing Card Log, Requisition, Direct Payment Form, or PIR).
Date: Event Location: On Campus Off Campus
Note: When held in the headquarter city for the majority of the attendees, the event must be held on campus.
Was a fee collected from participants to cover costs? Yes No
1. Allowable Expenses: (Must pertain to event)
Facilities were not available within the building or immediate area, allowing attendees to obtain and consume normal break items within a break period of 10 to 20 minutes.
Having the attendees leave the meeting room would have had an adverse effect on the continuity of the meeting.
The majority of attendees were not UW/State employees. (Board members and students are not considered employees.)
2. Reasonable Approved Expenses: (Must pertain to event)
Refreshment break expenses must be limited to one break each morning and afternoon. The break may consist of nonalcoholic beverages and/or small food items and the total cost may not exceed $10.00 per person per break. Events that include a continental breakfast may not include additional food items at the morning break.
3. Documentation Requirements: (Provide information requested in “Description of the event” category if detailed agenda is not attached)
Description of Event:
Event Name:
Business Purpose:
Number of attendees:
Date and time (beginning and ending):
Meeting agenda, which includes above information, is attached.
4. Proof of Payment: (Check the box that pertains) 
Itemized invoice/receipt showing amount paid is attached.
Vendor will submit original invoice. (When form is used as part of the purchase order process.)
(Signature of Approving Official) Not required if included in the payment mechanism.