If you are requesting that the HSA reimburse you for incurred expenses, you must complete this form and attach receipts/invoices.
NO SALES TAX CAN BE REIMBURSED BY THE HSA. Please give vendors the HSA's tax-exempt certificate available here.
If you are requesting that the HSA pay a vendor or reimburse you for incurred expenses, you must complete this form and attach receipts/invoices.
NO SALES TAX CAN BE REIMBURSED BY THE HSA. Please give vendors the HSA's tax-exempt certificate:
Tax Exempt Certificate
Instructions:
1. Receipts/Invoices must show date incurred, amount of expense and items purchased
2. A receipt of your submitted request will be emailed to you (keep for your records).
If you a question about your budget, please reach out to Maugham School HSA at maughamschoolhsa@gmail.com.
All reimbursements will be sent by check in the mail in approximately 7 days from processing.
