WESTERN PENNSYLVANIA ELECTRICAL 5 HOT METAL STREET SUITE 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the 'Participant’s Name' field. Ensure that your name matches the one on your WPEE ID card.
3. Next, fill in your date of birth in the designated field. This information is crucial for verifying your eligibility.
4. Locate your ID number from your WPEE ID card and enter it in the ID# field. Remember, do not use your Social Security Number for security reasons.
5. After completing these fields, ensure you have a sales representative sign off on the certificate section after purchasing the boots. They must confirm that the boots meet ANSI specifications.
6. Finally, attach your receipt to this form and submit it to the W.P.E.E. Insurance Trust Fund office for reimbursement processing.

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