REIMBURSEMENT REQUEST

Members must read and accept the following policies before completing the form.

Only the primary member on the account may request an invoice for employer reimbursement.
Membership type, rate or status adjustments cannot be made after the fact to meet employer reimbursement requirements.
Statements cannot be customized.
• Statements include both membership dues and house account charges.
• Itemized statements are not available.
• We are unable to remove or modify specific charges.
Billing schedule reminders
• Invoices are billed on the 1st of each month.
• House account charges from the previous month are billed on the 10th of each month.
• Membership dues for the upcoming month are billed on the 15th of each month.
Employer reimbursements cannot be applied to house account balances.
• House account charges may appear on your statement but cannot be used toward reimbursement unless explicitly approved by your employer.
• Our system cannot separate dues and house account items. If your employer does not cover the full statement amount, please review this before submitting a request.
If employer reimbursement only applies to primary account holder and the member wants documentation to only reflect the primary, secondary members must be separated from the primary membership account and this cannot be done retroactively.
• To separate billing or create reimbursement documentation for secondary members, please use the Split Membership Form.
• Splits cannot be applied retroactively.

Company
This field is for validation purposes and should be left unchanged.
Member Name*
Member Number or Phone Number*
Email*
Your reimbursement documentation will be sent to this email address.
Employer Name*
Position*
Employment Status*
- Part-Time Employee
- Full-Time Employee
Annual Reimbursement Amount or Percentage*
Reimbursement Request Begin Date*
Your reimbursement documentation will contain all membership dues and house account charges beginning on this date.
MM slash DD slash YYYY
Reimbursement Request End Date*
Your reimbursement documentation will contain all membership dues and house account charges ending on this date.
MM slash DD slash YYYY
Confirmation*
I have read and understand the policies listed above in regards to my Reimbursement Request.

YOUR CLUB AWAITS