CASHNet Refund Request Form

Department
Date

Original Transaction: #
Date
Amount $
*Transaction number is the "Receipt #" located at the top of the CASHNet receipt.

Refund Amount $
*This is the amount that will be credited back to the customer's credit card

Print Name:
Approved By
:


Date

E-mail
ext.
*Confirmation of completed transaction will be sent to this e-mail address.