Decoda Reimbursement Request Form
Please fill out this form to have a Decoda-related business expense be considered for reimbursement. Upon submission, the Decoda Leadership Team will review the expense and if approved, reimbursement will be issued within 5 business days. Thank you!
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Name
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First Name
Last Name
Email
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example@example.com
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Description of the expense and how it relates to Decoda. (be specific!)
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What is the total amount of reimbursement you are requesting? (this must be verified by receipts)
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Please upload all receipts here as separate documents (PDF required).
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Browse Files
Drag and drop files here
Choose a file
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Has your banking information changed since the last time you were issued a payment from Decoda?
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Yes
No
Please provide your updated bank name.
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Please provide your updated account number.
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Please provide your updated routing number.
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Signature: Please e-sign
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Submit
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