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Get AL BeneTech Administrators Request For Reimbursement 2010-2024

Returned unpaid) MAIL, FAX, or EMAIL completed form to: BTA - FSA Claims P.O. Box 530967 Birmingham, AL 35253 Fax: 205-879-2181 (Do Not Mail if Faxed) Email: claims btai.com REQUEST FOR REIMBURSEMENT Employer: Employee Name: SSN: Last, First MI Home Address.

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