Forms Volunteers Need

Reimbursement Form

Use this form to submit reimbursements for purchase you made to support HSA activities. 

Pennsylvania Exemption Certificate REV-1220

Merion HSA is a 501(c)(3) charitable organization with a tax exempt number. The tax exempt number allows purchases for HSA activities to be excluded from having sales tax applied. If you are purchasing a taxable item, then you may request a copy of the Pennsylvania Exemption Certificate form to give to the seller. Please always check with customer service at a store before heading to the register. Many stores have registration procedures in place. We also have tax exempt customer numbers for certain stores. Click on the above link to request a copy of the form or to confirm if we are registered at a certain store already.

Record of deposit form.