Non-Employee
Reimbursement Form

For reimbursing individuals who are not Pattern employees (e.g. contractors, partners, vendors). Complete all fields and upload your receipt(s) below — Accounts Payable will process electronic payment from there.

Before you submit Amounts must match the attached receipt exactly, and bank information must include the country where the account is held.

Recipient Information

Who is being reimbursed?

Full Name *

Phone Number *

Email Address (optional)

Address *

Reimbursement Details

Amount and internal budget

Amount to Reimburse must match receipt *

Which Pattern subsidiary (company) or region is paying this reimbursement? *

Department Budget for This Reimbursement (optional)

Electronic Payment / Bank Information

We'll send an electronic payment — please provide the following

Bank Name and Address please include the bank country *

Account Number *

Wire: ABA (US Routing) or Other (if applicable)

SWIFT / BIC (if applicable)

Beneficiary Name (name on bank account) and Address *

Receipts & Backup Documentation

Upload receipts, wire/EFT info, bank letter, or a voided check

Upload Receipt(s) / Backup Documents *

📎

Click to upload or drag and drop
PDF, JPG, PNG, or DOC — 4MB combined limit

Requestor Certification

Pattern team member submitting this request

Team Member Name *

Team Member Email *

I certify that the information provided above is accurate and that the attached receipt(s) match the amount requested.

Submitting creates a ticket directly in Freshservice, with your receipt(s) attached.

Non-EmployeeReimbursement Form

Non-Employee
Reimbursement Form