WeCU Reimbursement Form for NVT (01)

This is the reimbursement request form for NVT (01) WeCU savings accounts.

* indicates required field

Name:*

Email:*

Area of Request:

1. Membership for activity/experience 2. Tickets for arts experiences 3. Professional/Personal development expenses 4. Subscription to support healthy eating 5. Materials for gardening 6. Services/appts with qualifying professionals

(IMPORTANT: The 6 items above have shortened descriptions. To view the full descriptions of approved 'Items', please click on the following link: 01 NVT Approved List. This link will open in a new tab that you can close after viewing.)

Description of Activity/Service:*

Date(s) of Activity/Service:*

Total Amount Requested:*

Attach Receipt/Proof of Purchase:*

Acceptable file types: doc,docx,pdf,txt,gif,jpg,jpeg,png.
Maximum file size: 5mb.

Attach Additional Receipt/Proof of Purchase:

CAPTCHA Code:*