Get Funds Transfer Form & Instructions - Lyfebank.com

This guide provides step-by-step instructions on how to properly fill out the Funds Transfer Form for medical expenses through Lyfebank. By following these instructions, you can ensure that your requests are processed efficiently and accurately.

Follow the steps to complete your Funds Transfer Form successfully.

1. Press the ‘Get Form’ button to obtain the Funds Transfer Form and open it in your preferred editor.
2. Begin by filling out your employer name and LyfeBank account number at the top of the form.
3. Enter your name, street address, city, state, zip code, phone number, and email address in the designated fields.
4. Select the type of funds transfer by marking an 'X' in the appropriate box for either repayment or direct pay.
5. For each medical expense incurred, provide the date the expense was incurred, name of the service provider, and a brief description of the expense.
6. Indicate the total net amount of the medical expense and calculate the total medical expenses.
7. Attach any required documentation, including invoices, bills, and proof of payment, ensuring all items contain the necessary details.
8. Sign and date the form at the bottom to certify that all information provided is accurate and that the expenses are qualified medical expenses.
9. Save your completed form, and if necessary, download, print, or share it as needed.

Complete your Funds Transfer Form online today to ensure your medical expense claims are processed without delay.