Employee Refund Reimbursement Form

Employee Reimbursement Form

Please complete the following and select submit form when completed.
Employees Direct Supervisor Name*

First NameLast Name
Employee Name*

First NameLast Name
Employee Phone Number*

Area CodePhone Number
Team Player ID
Employee Number
Club to be charged:*
Club Name & State
Email*
example@example.com
Purchase Category*
What was this purchase used for.
Vendor Name
Receipt/Dues Date

MonthDayYear
Refund Request Amount*
What was the method of payment used for this purchase?*

Cash/checkcc/eftPaid with petty cash
How would you like the refund processed?*

CheckDirect Deposit
Employee Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By selecting Direct Deposit you understand and agree to Excel Fitness utilizing and accessing your routing and account number in Workday.
Submit a photo/copy/PDF of the receipt/Invoice by uploading it below.
Allowable file formats: .jpg, .gif, .png, .pdf*

Upload a File

Cancelof
Reason for reimbursement or additional details*
Please explain the details of the reimbursement. If for a staff outing explain what the cost was associated with. Example: Food for external staff meeting.
Should be Empty:

Employee Reimbursement Form