WESTERN PENNSYLVANIA ELECTRICAL 5 HOT METAL STREET SUITE 2026

1. Click ‘Get Form’ to open the WORK BOOT BENEFIT FORM in the editor.
2. Begin by entering your name in the 'Participant’s Name' field. Ensure that it matches your identification documents.
3. Next, fill in your date of birth in the designated field to verify eligibility.
4. Locate your ID number on your WPEE ID card and input it into the ID# field. Avoid using your Social Security Number for security reasons.
5. In the 'Date of purchase' section, enter the date when you bought the work boots.
6. Fill out the 'Place of purchase' and 'Telephone number' fields with accurate information for verification purposes.
7. Have a sales representative sign off in the 'Signature of sales representative' section, certifying that the boots meet ANSI specifications.
8. Finally, attach your receipt to this form and submit it as instructed to ensure reimbursement.

Start filling out your form today for free and streamline your reimbursement process!