CDL Reimbursement Request Form
I have presented proof of obtaining a CDL License along with receipt for payment to the S.E.T. Fund for reimbursement to me. By signing this form, I acknowledge receipt of such reimbursement in the amount not to exceed $3,500.
Date of Submission
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
First Name
Last Name
Email Address
*
Member Book Number
*
Phone Number
*
Last 4 of Social Security Number
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Required Documents:
Please upload the FRONT of your MEMBER BOOK
Please upload the BACK of your MEMBER BOOK
Please upload your DOT MEDICAL CARD
Please upload the FRONT of your DRIVERS LICENSE
Please upload the BACK of your DRIVERS LICENSE
Please upload your RECEIPT(s)
Submit
Should be Empty: