WRC Refund Form
WRC Refund Form
Thank you for taking the time to complete this form!
Where did the transaction take place?
*
Where did the transaction take place?
BBC
MMC
Online
Section A: Requester Information
Requester Name:
*
Email
*
Are you the person who paid for the service?
*
Are you the person who paid for the service?
Yes
No
If no, please indicate relationship to payee.
Primary Contact Number
*
Panther ID or Guest Number:
*
Reason for requesting refund:
*
Payment Method:
*
Payment Method:
Credit Card
FIU OneCard
Payroll Deduction
Other
Other
Name as it appears on card:
Date of transaction:
Date of transaction:
/
MM
/
DD
YYYY
Amount of refund requested in dollars:
$
Dollars
.
Cents
Location of Transaction
*
Location of Transaction
Modesto Maidique Campus
Biscayne Bay Campus
The Virtual WRC
Other
Other
Supporting Information, statement of justification
Today's date:
Today's date:
/
MM
/
DD
YYYY
Section B: TERMS AND CONDITIONS
The full WRC Refund Policy can be found at go.fiu.edu/wrcpolicies.
This form is effective for one transaction at a time. A separate form is required for each request.
All refunds must be approved by the appropriate area administrator prior to processing.
Refunds will credit the original card used for the purchase and may take several days to post to the account.
The amount of refund will be confirmed by administration. If a refund is not available, patrons may qualify for a credit toward future services or products.
Incomplete forms may cause a delay in your refund request.
Payroll deductions may take more than one payroll cycle for the refund to be credited.
I have read and understand the above terms and conditions.
*
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.
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