• Step 1 - Enter Your Contact Info

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  • Step 2 - Submit Your Expenses

    To submit your reimbursement request, complete the form below and attach your receipt(s). Please ensure the receipt(s) you submit shows the date of purchase, the amount to be reimbursed, and the item for reimbursement.

    Submitting your expense(s) does not guarantee reimbursement. Within 5-10 business days of your submission, you will receive an email notification that your request has been approved or denied. For questions, please call the support line at (317) 343-2746, available Monday through Friday from 9:00 am to 5:00 pm EST, or email

    FORUM Credit Union Wellness Bucks

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  • Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 50 MB.

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