Payflex Reimbursement Account Claim Form - Sep 2013

This form is used to request reimbursement from an employee's Payflex account for eligible expenses. The form requires the employee to provide their personal and account information, as well as details about the expenses they are claiming. Employees must also attach any necessary receipts or documentation to support their claim.

Employees with a Payflex account who have eligible expenses to claim.

The completed Payflex Reimbursement Account Claim Form should be submitted to Payflex along with any necessary receipts or documentation.