Reimbursement Form

Reimbursement Request
Tenant Details
Payment of Reimbursement
Agreement Terms

The applicant acknowledges and understands that reimbursement funds if granted will be transferred into the above account via electronic transfer and verifies that the above listed bank account is correct.

The applicant acknowledges and understands that a valid receipt is required in order for a reimbursement request to be processed. Upload a scan above, email your receipt to reception@bolitho.co.nz or post to 2 Cambridge Street, Richmond 7020.