ASSOCIATE CELLULAR VOICE AND 
DATA REIMBURSEMENT FORM
Associate Name: __________________________________________
(Last Name, First Name)
Location: ________________________________________________
Position: _________________________________________________
Cell Phone Number: ________________________________________
Name of Cell Phone Provider: ________________________________
Monthly reimbursement for voice only is $45.00 per month.
Approval must be obtained for an additional $20/month data reimbursement.
**Please attach a copy of your cell phone bill showing your charges and submit to your General Manager and the IT Director for approval. Data reimbursements are only available to specific positions with approval.
I have read and understand the JX Enterprises, Inc. Cellular Voice and Data Reimbursement Policy. I agree to be available to answer calls & emails after hours, display my cell phone number on business cards and email signatures and that my number will be posted internally.
I understand that termination of my employment, for any reason, results in the sacrifice of any future payments under this reimbursement plan.
I also understand that the Management of JX Enterprises, Inc. may amend or terminate the Plan at any time.
Signature: ______________________________ Date: ____________________
Manager/GM Approval: ______________________ Date: ____________________
Corporate Approval: ___________________________ Date: ___________________
Complete and Email to mschmidt@jxe.com
For Payroll Use Only:
Date received in Payroll:___/____/_____
Date entered into Ultipro:___/_____/____