EmailMeForm
Refund Request Form
To request a refund for a payment made to the United States Police Canine Association Region 12, please provide as much of the following information as possible. All of the information requested should be on the receipt provided at the time of payment. Each field is not required, however providing as much information as possible will expedite the refund process.
Date of Refund Request
*
MM
/
DD
/
YYYY
Name of Person Requesting Refund
*
First
Last
Phone #
*
###
-
###
-
####
Email
*
Item being refunded (PD1 trial, Detector Trial, Seminar, ect.)
*
Date of Payment
MM
/
DD
/
YYYY
Name on the credit card used for payment
Name on Credit Card
First
Last
Name on Credit Card
First
Last
Email address used for payment
Email
Transaction ID
Any Additional Information to Help Process the Refund
