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Refund REquest Form
INTERNAL USE ONLY
If a student or customer is requesting a refund, fill out the form below to send to accounting.
Submitted By
(Required)
Select One
Benjamin Breier
KJ Steir
Glory Solomon
Monette Balondo
Mimi Welch
Nya Carpenter
Robert Carter
Roxanne Pedrera
Sheena Marie Fong
Teesha Baltazar
Toni Jackson
Name
(Required)
First
Last
Email
Phone
Refund Requested For
(Required)
Book Purchase
Course/Coaching
Products (shirts, phone cases, etc...)
Podcast Interview
Subscription Service (IE: REI Monthly)
Event Ticket
Other
Date of Purchase
If needed, enter an approximate date.
MM slash DD slash YYYY
Please Specify The Product or Services Indicated Above:
(Required)
Briefly Explain What Concerns the Student is Experiencing
(Required)
Noelle Randall
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