FBC Reimbursement

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FBC Reimbursement

For reimbursements, please fill out the following form. After filling the form out, you will receive a Docusign email, which needs to be signed to complete your reimbursement request. You will attach your receipts to the DocuSign. If additional information is needed for your request, you will be contacted by email or phone.

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電子郵件 *

Name (First and Last name) *

Street Address *

City, State, Zip Code *

Email Address *

Phone Number *

Reimbursement Amount *

Reimbursement Fund (Select 1 fund per submission). If you do not know the correct fund, note the reason for the reimbursement at the bottom of this form.) *

Reimbursement Method: (How you wish to receive payment.) *

Check

Zelle

Notes (optional):

系統會透過電子郵件將你的作答內容複本傳送到你所提供的地址。

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