Home Employer electronic funds transfer (EFT) application form Employers can use this form to receive any reimbursement of weekly payments and medical services over the employer excess.Download PDFLast updatedMay 2013Reading levelmediumFile type and size PDF, 74.98 kB Document length1 pageShare this page Share this pageShare on FacebookShare on LinkedinShare on TwitterShare via Email What it contains Blank form with supplementary notes and information. Was the information on this page helpful? feedback optionsYesNoTell us more (optional)Submit feedback