Reimbursement Form

Thank you for getting a flu shot – it’ll help keep you and our clients healthy and well

To receive a reimbursement for the cost, please fill out all your details below, attach a copy of your receipt, and press ‘Submit’.

If you have any questions about this process, please contact comms@zenitas.com.au

Reimbursement Form

If you are human, leave this field blank.

First Name *

Surname *

Email Address *

Phone *

Which business do you work in? *

Date of flu shot *

Provider *

Please attach a copy of your tax invoice to show payment made. *

Maximum upload size: 5MB

Please note, without a valid tax invoice attached your payment will not be processed

Bank Account Details

Please provide your banking details and we’ll credit the cost of the flu shot to your bank account

Account Name *

BSB *

Account Number *

Amount of reimbursement *

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Please check BSB and account numbers carefully, as entering incorrect details may result in the wrong account being credited and the funds may not be able to be recovered

Reimbursement Form

Thank you for getting a flu shot – it’ll help keep you and our clients healthy and well

Bank Account Details

Members of:

Acknowledgement of Land