PAYMENT FORM

Payments and Reimbursement Form InCube

If you have any questions, please contact finance@entrepreneur-club.org
Your First Name*
Your Last Name*
Your Email*
Use your EC email!!
Amount *
Please refrain from using commas as money separators.
Currency*

CHFEURUSDOther
VAT (%) on receipt*
Did you already create an account? (Do we know your bank details?)*

YesNo
!ATTENTION!
Your account is identified by the email address you entered above!
Create a Contact

Since you answered that you did not create a Contact so far, we will need some of your personal and bank account details.
Personal Details
Street address and number*
City*
Postal / Zip Code*
Country*
Bank Account Details
Bank name*
Street address and number of your bank (the branch you frequent or headquarter)*
City your bank is in (the branch you frequent or headquarter)*
Zip code (the branch you frequent or headquarter)*
Country of your bank*
Account currency*
IBAN (no spaces)*
Repeat IBAN*
Entered IBAN is not identical!
Accounting Data
Account*
If "other" please describe below
What term is this payment relevant to?*
Short description of expense*

0/400
Upload your receipts (max. 5 Mb). NO Invoices!*

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Enter the message as it's shown*
With this signature I agree that the ETH Entrepreneur Club can use and store the collected data to complete the requested reimbursment.
Signature*

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Payments and Reimbursement Form InCube