Refund Request Form

This form is used by customers to formally request a refund for a product or service. Please provide all relevant details to process the request accurately and efficiently.

Customer Information

Full Name: {fullName}

Email Address: {email}

Phone Number: {phoneNumber}

Order Number: {orderNumber}

Date of Purchase: {purchaseDate}

Product or Service Details

Product/Service Name: {productName}

Product/Service ID (if applicable): {productId}

Price Paid: {pricePaid}

Reason for Refund

Please describe the issue or reason for requesting a refund:

{refundReason}

Supporting Attachments Provided

The customer has included the following attachments to support their refund claim:

{#hasAttachments}

• {attachmentName}

{/hasAttachments}

{^hasAttachments}

No Attachments Included

The customer has not included any files or evidence with this refund request.

{/hasAttachments}

Preferred Resolution Method

Preferred Refund Method: {refundMethod}

Additional Comments: {additionalComments}

Products/Services Being Returned

Declaration

I, {fullName}, declare that the information I have provided in this form is accurate and complete to the best of my knowledge. I understand that submission of this form does not guarantee a refund and that additional information may be requested.

Date of Submission: {submissionDate}

Customer Signature (typed): {customerSignature}