REFUND  REQUEST  FORM   Refund requests can be facilitated by: 1. Emailing Refund Request Form to [email protected] 2. Submitting Refund Request Form to the Smith Center for Recreational Sports Front Desk in the Duncan Student Center 3. Sending Refund Request Form via campus mail to: RecRegister Refund, RecSports – 319 Duncan Student Center 4. Faxing Refund Request Form to (574) 631-4818 Name: _____________________________ Phone number: (______) ______ - ________ Date submitted: ___________ Street address: ______________________________ City: _______________________ State: ______ Zip: __________ netID: (jsmith1) _______________ Order number: _____________ *Required – located on email confirmation/receipt.

INTRAMURAL SPORTS REFUND INFORMATION Sport: __________________________ Day of play: ______________ League: _______________ League time: __________

CLASSES REFUND INFORMATION Type of class: _____________ Class name: ___________________ Day of week: ______________ Class time: __________

FAMILY FUNDAYS REFUND INFORMATION Family FuNDay: ______________________ Date of Family FuNDay: __________ Name(s) of registrants requesting refund for:____________________________________________________________

REASON FOR REFUND REQUEST ________________________________________________________________________________________________ ________________________________________________________________________________________________ TOTAL AMOUNT OF REFUND REQUESTING: _____________ ORIGINAL METHOD OF PAYMENT Credit card

* Refund will be issued to credit card after approval. DO NOT include credit card number.

Cash or check * Once approved, you will receive a refund in 2 – 3 weeks in the form of a check. SIGNATURE: __________________________________________ Date: ________

RecSports Use Only Date received: ________ SKU number: _____________________ Staff initials: __________ Refund applied via? __ TouchNet __ Moneris __ Check __ No refund // __ Fusion

DIVISION OF STUDENT AFFAIRS

Refund amount: _______