OSWC Payment & Reimbursement Form OSWC Payment & Reimbursement Form Please fill out this form to be reimbursed for any approved expenses. There is a space below to upload any necessary receipts and a W9 Email * Is this for payment for services or reimbursement of expenses? * Payment Expenses What is this payment or reimbursement for? * Approval of Expenses by.. * Legal Name * Name by which you are known * Preferred method of payment. Please note – these are the only options available for reimbursement * Zelle -(NOTE: Your account must be connected to your bank. We cannot Zelle to a debit card!) please include email address or phone number associated with this account in the next field) Paper Check (include the address where we should mail the check in the next field) Zelle – email or phone number associated with account. Paper Check Date of pay period Is this a recurring payment? * Yes No If this is a recurring payment, how frequently is this payment to be made? If this recurring payment has an end date, what is it? What is the total amount for this payment? * Please upload any supporting documentation for the expenses here. If you have more than 10 items, email [email protected] * Drop a file here or click to upload Choose File Maximum upload size: 52.43MB If you have not filled out a w9, please click the link below, fill one out, and attach it below once it is completed. https://www.irs.gov/pub/irs-pdf/fw9.pdf * Drop a file here or click to upload Choose File Maximum upload size: 52.43MB If you are human, leave this field blank. Submit Δ
