Here's how it works
01. Edit your flexfacts claim form online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send flexfacts claim via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out Please send this form along with all applicable receipts to: with our platform
- Click ‘Get Form’ to open it in the editor.
- Begin by filling out your personal information. Enter your full name, employer, last four digits of your Social Security Number, phone number, and email address in the designated fields.
- If your address has changed, provide the new address along with the city, state, and zip code.
- In the FSA Claim Information section, specify the type of expense for each entry. Include the date and amount for each medical expense incurred.
- Ensure you complete all required fields for each type of expense listed. You can add multiple entries as needed.
- Finally, sign and date the form at the bottom to confirm your agreement with the terms stated.
Start using our platform today to easily fill out and submit your claims form for free!
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