Refund Request |
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| Location Name:
Today's Date:
(MM/DD/YY) |
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| First and Last Name:
Email: |
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Product:
Price: $
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Date Lost:
Time of Lost:
Amount Lost: $
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Refund Payment Method
*For credit refunds, please provide the last 3 digits of the card used:
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Comments:
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If you are a visitor of this location, you may select "check" or "credit" as your refund payment method. To receive a check refund, please provide your address information below. All refunds are processed immediately. However, depending on courier times, delivery may take 2 to 3 days. |
| Address 1:
Address 2:
City:
State:
Zip: |
Enter Security Code:
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