Customer Refund Request
Please fill in all information and upload a copy of receipt or any other supporting documentation available.
Name of Manager Submitting Request
Store Email (for refund receipt)
Date of Transaction
Type of Transaction
Check Number or Online Order Number
Last 4 of Card Number Used
Amount of Original Transaction (excluding tip)
Amount of Tip (if applicable)
***ONLY ENTER IF THERE IS A TIP APPLIED TO THE ORDER, OTHERWISE LEAVE BLANK
Amount of Refund Requested (including any tip to be refunded)
Reason for refund or any additional requests/info
Copy of Receipt/Supporting Documentation
Please make sure the payment portion of the receipt is showing if available.