Can I sign electronically?

Yes. Electronic signatures are valid under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and record retention are met. Exception rules may apply to certain court filings and testamentary documents.

Is notarization required?

Not usually required for standard entitlement statements unless a contract or state law specifically mandates notarization; if needed, consider remote online notarization where permitted and verify state rules for retention of audio-video records.

What if the TIN is wrong?

An incorrect TIN can trigger backup withholding at 24% and IRS notices. Correct the record promptly and provide the payer with an updated W-9 or corrected vendor information to avoid future withholding.

Which supporting documents are essential?

Include invoices, executed contracts, remittance advices, and any program-specific authorization. Clear cross-references between line items and attachments speed review and reduce disputes.

How long should I keep records?

Retain records per applicable standards: at least 3 years for IRS purposes (IRC §6501(a)) and 6 years for HIPAA-related materials (45 CFR §164.530(j)); longer retention may apply by state or industry rule.

Can we use bulk send for multiple claims?

Bulk send is supported by many eSignature platforms and is useful for standardized forms; ensure each recipient receives a uniquely populated statement and that audit trails are preserved per recipient.

Electronic Signature
Templates
Finance
WEX Financial Statement of Entitlement

WEX Financial Statement of Entitlement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

WEX Financial Statement of Entitlement

Use this Financial Statement of Entitlement to assert and document a claimant's entitlement to funds or credits currently held, pending or administratively reserved by WEX. Complete all applicable fields, attach supporting documentation, and sign the certification. Incomplete statements may be returned for clarification or denied.

Claimant Information

Client Name:

WEX Account Number:

Tax ID / EIN:

Business Address:

Contact Person:

Title:

Phone:

Email:

Entity Type (select all that apply)

Corporation Partnership Sole Proprietor Government Entity Other

Statement of Entitlement

Claimant asserts entitlement to funds held by WEX in connection with the transactions identified below for the period beginning and ending . Provide a complete, itemized schedule of transactions and attach supporting documentation. If additional rows are required, attach a separate schedule that mirrors this format and reference it here:

Date	Reference / Transaction ID	Vendor / Counterparty	Description	Original Amount	Claimed Amount

Subtotal: Adjustments (describe): Total Entitlement:

Payment Instructions (Optional)

If claimant requests direct remittance, complete the banking information below. Claimant authorizes WEX to effect payment to the account provided below should the claim be approved.

Bank Name: Account Holder Name:

Routing Number:

Account Number:

Checking Savings I authorize WEX to credit the account above if this entitlement is approved

Attachments Checklist

Check all attachments included with this Statement of Entitlement:

Invoices / Billing Statements Contracts / Purchase Orders Proof of Delivery / Receipts Copies of Correspondence / Dispute Records Other (describe below)

If Other, describe:

Certifications and Authorization

By signing below, Claimant certifies under penalty of perjury that the information provided in this Statement of Entitlement and all attached documentation are true, complete and accurate to the best of Claimant's knowledge. Claimant further represents that it is the lawful owner of, or otherwise entitled to, the amounts claimed herein and that no other person or entity has a superior right to the funds identified.

Claimant authorizes WEX and its agents to verify any information provided, to seek confirmation from third parties, and to exchange information reasonably necessary to investigate and process this claim. Claimant agrees to indemnify, defend and hold WEX harmless from and against any losses, liabilities, costs or damages arising from false statements, misrepresentations or failure to disclose material facts in this statement.

Claimant acknowledges that approval of this Statement of Entitlement is at the sole discretion of WEX and that WEX may condition any payment on receipt of additional documentation, release forms, or satisfaction of contractual or regulatory requirements. Claimant agrees that any payment made in reliance on this statement may be recovered if found to be made in error.

Additional Comments or Notes:

Claimant Printed Name:

Signature:

Date:

What the WEX Financial Statement of Entitlement Is

The WEX Financial Statement of Entitlement is a formal financial declaration used to document an entity's claimed entitlement to funds, credits, or allocations managed through WEX-related programs or vendor relationships. It summarizes the claimant's identity, the entitlement basis, supporting calculations, and any contractual references that establish the right to payment or credit. The document is typically used by finance, treasury, or vendor management teams to support disbursement requests, reconcile accounts, or meet audit requirements and should be retained as part of the organization's fiscal records.

Why a Clear Statement of Entitlement Matters

A complete and accurate statement simplifies approvals, reduces payment delays, and creates an auditable record that supports internal controls and external review.

Who Prepares and Reviews This Statement

Typical preparers and reviewers span finance and legal functions, plus external vendors and auditors.

Corporate Finance teams preparing entitlement requests and reconciliations, responsible for the numbers and supporting schedules.
Vendor or supplier representatives submitting entitlement claims tied to invoices, chargebacks, or program credits.
Internal Audit and external auditors who rely on the statement as evidence during financial review or compliance testing.

Assign clear ownership for preparation, approval, and record retention to reduce processing errors and control risk.

Core Components to Include in a Professional Statement

An effective WEX Financial Statement of Entitlement contains clearly labeled sections for identity, entitlement basis, calculations, supporting documents, approvals, and version control to ensure traceability and auditability.

Claimant Identity

Full legal name, taxpayer identification or vendor ID, and contact information to uniquely identify the requesting party.

Entitlement Basis

Concise legal or contractual justification explaining why the amount is owed, referencing agreement clauses, dates, or program rules.

Monetary Calculation

Line-item calculation showing gross amounts, adjustments, credits, and net entitlement with currency and rounding conventions specified.

Supporting Attachments

Invoices, receipts, contracts, or remittance advices attached or referenced by filename and date for audit traceability.

Authorization

Name, title, signature, and date of the individual certifying the claim, plus countersignature if required by policy.

Version Control

Document ID, revision number, and creation or effective date to track amendments and historical records.

Step-by-Step: Completing the Statement

Follow these sequential steps to prepare a submission that is complete, verifiable, and ready for approval.

01

Collect Source Documents: Gather invoices, contracts, and remittance records before starting.
02

Populate Identity Fields: Enter exact legal names and identification numbers.
03

Calculate Entitlement: Show line-by-line math and total the net amount.
04

Sign and Attach: Obtain required signatures and include all supporting files.

Typical Digital Workflow Configuration

A standard eSubmission workflow routes the completed statement for approval, captures signatures, and archives the final record.

Field	Configuration
Submitter	Finance user or vendor email
Reviewer	Treasury or vendor manager
Signer	Authorized signatory (1 or 2 depending on policy)
Archive	PDF with audit trail stored in records system

How Electronic Submission and Approval Works

Electronic workflows reduce manual handoffs by automating routing, authentication, and record capture while preserving an audit trail.

Upload: Sender uploads the completed statement and attachments.
Place Fields: Signature, date, and data fields are placed on the document.
Authenticate: Signer verifies identity by email, SMS code, or stronger methods.
Complete: Signed PDF and audit trail are returned to all parties.

Technical Considerations for eSubmission Platforms

Confirm platform capabilities for document format, authentication, and archive before choosing an eSubmission method.

Supported Formats: PDF, DOCX, XLSX
Authentication Options: Email link, SMS, KBA, SSO
Integrations: CRM, ERP, cloud storage

Key Timing and Processing Expectations

Understand processing cutoffs and internal SLA targets to prevent missed accounting periods or delayed disbursements.

Submission Timing:

Submit before month-end close to ensure same-period processing.

Approval SLA:

Typical internal approval is 3–5 business days for standard claims.

Disbursement Window:

Payments often scheduled on the next payment run after approval.

Reconciliation:

Allow 1–2 accounting cycles for reconciliation and exceptions.

Retention Start:

Retention begins on the statement effective or signed date.

Milestones from Preparation to Payment

Sequence the key stages below to keep the claim on schedule and auditable from start to finish.

01

Preparation

Assemble documents and complete the statement with calculations and IDs.

02

Internal Review

Finance or legal checks entitlement basis and supporting evidence.

03

Approval

Authorized signatory confirms accuracy and signs the document.

04

Payment/Reconciliation

Finance schedules payment and records the transaction for audit.

Security and Compliance Controls to Expect

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

Audit Trail: Timestamped actions and IP logs

Access Controls: Role-based permissions and SSO

Regulatory Certifications: SOC 2 Type II, ISO 27001

Healthcare Support: HIPAA with BAA available

FDA Records: 21 CFR Part 11 options

Consequences of Inaccurate or Late Statements

Tax Penalties: IRC §6721 penalties for incorrect filings

Withholding Risk: 24% backup withholding for wrong TIN

I-9 Fines: I-9 paperwork violations: $281–$2,789

Contract Disputes: Payment denial or offset claims

Audit Findings: Increased audit exposure and remediation costs

Reputational Damage: Vendor relationship strain and service impacts

Common Preparation Pitfalls to Avoid

Mismatched names or TINs between the statement and tax records that trigger withholding or rejection.
Absent or unclear linking of supporting invoices and contracts, causing extended validation cycles or denials.
Improper date formats or arithmetic errors in calculations that invalidate the entitlement amount.
Missing authorization or incorrect signer authority that requires re-signature and delays payment.

How This Statement Differs from a Standard Financial Statement

Compare the WEX Financial Statement of Entitlement with a general financial statement to understand purpose and handling differences.

Criteria	WEX Financial Statement	Standard Financial Statement
Primary Purpose	entitlement claim	financial position
Notarization	optional	optional
Supporting Docs	invoices/contracts	comprehensive schedules
Retention	accounting retention	corporate records

eSignature Pricing Snapshot for Completing This Document

Pricing and feature comparisons can inform which eSignature provider meets authentication, compliance, and volume needs when submitting financial entitlements.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/yr	Varies	Varies	Varies

Real-World Examples of Usage and Outcomes

Examples show how companies used secure eSigning and structured statements to speed approvals and create auditable records.

Optica Ventures

Finance team standardized entitlement forms to reduce back-and-forth verification.

Resulted in fewer follow-ups and clearer audit trails.
The streamlined process made external vendor submissions consistent and reduced review time across all portfolio companies, improving internal controls and record quality.

Martin Properties

Property manager submitted vendor credit claims with full supporting documentation.

Enabled immediate validation and payment scheduling.
The combined statement and digital signature approach eliminated in-person meetings and improved payment accuracy while preserving essential documentation for audits.

Practical Tips for Accurate and Efficient Preparation

Adopt these practices to reduce errors, speed approvals, and preserve a clear audit trail.

Use a Standard Template

Standardized fields and examples ensure all claimants provide consistent information and reduce reviewer ambiguity during validation.

Attach Indexed Evidence

Number and reference supporting invoices and contracts so reviewers can quickly match claims to source documents without repetitive requests.

Validate IDs Before Submission

Confirm legal names and tax IDs against vendor records to prevent withholding or rejection for mismatched data.

Keep an Audit Trail

Capture signer identity, timestamps, and IP information to support non-repudiation and meet internal and external audit requirements.

Who Is Authorized to Sign

Finance Manager

A Finance Manager with delegated authority typically prepares and certifies entitlement calculations and attachments, and is expected to follow internal approval thresholds.

Authorized Signatory

An authorized officer or signatory defined in corporate resolution must execute and date the statement to bind the organization for payment purposes.

Frequently Asked Questions

Answers to common questions about validity, signing, and recordkeeping for the WEX Financial Statement of Entitlement.

Need help? Contact support

Can I sign electronically?
Yes. Electronic signatures are valid under the federal ESIGN Act (15 U.S.C. ch. 96) and UETA in most states when intent, consent, attribution, and record retention are met. Exception rules may apply to certain court filings and testamentary documents.
Is notarization required?
Not usually required for standard entitlement statements unless a contract or state law specifically mandates notarization; if needed, consider remote online notarization where permitted and verify state rules for retention of audio-video records.
What if the TIN is wrong?
An incorrect TIN can trigger backup withholding at 24% and IRS notices. Correct the record promptly and provide the payer with an updated W-9 or corrected vendor information to avoid future withholding.
Which supporting documents are essential?
Include invoices, executed contracts, remittance advices, and any program-specific authorization. Clear cross-references between line items and attachments speed review and reduce disputes.
How long should I keep records?
Retain records per applicable standards: at least 3 years for IRS purposes (IRC §6501(a)) and 6 years for HIPAA-related materials (45 CFR §164.530(j)); longer retention may apply by state or industry rule.
Can we use bulk send for multiple claims?
Bulk send is supported by many eSignature platforms and is useful for standardized forms; ensure each recipient receives a uniquely populated statement and that audit trails are preserved per recipient.

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