Requestor's Name Who is requesting the refund? The person or business demanding a refund. Requestor's Mailing Address Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Requestor's Contact Info Phone Number E-Mail Refund Letter Date Enter the Date of this Refund Letter: Usually today's date. Refund Request Who is this Letter to? Party the refund is being requested. Type of Refund What is being Refunded? What is being Refunded? Cash ($)Credit Enter Amount $ Describe the Product or Service Describe what is being Refunded: Reason for Return What is the Reason for the Refund? Write a response that you believe will have a high chance of being accepted. It is recommended to review any refund policy. Due Date Refund must be paid by: Usually within 30 days. A due date is required for the letter to be valid. Sign and Print It is recommended to sign this letter by the person requesting the refund. Sign and Print Clear Please draw your signature. Print Name Next Save Save and finish later
