Refund Request

Please use the form below to request a refund.

Refunds will be issued for mechanical issues only.

Property, Company, or Institution Name required

Building/Dorm Name or Number required

Time required

Date required

Floor Number

Serial Number required

Machine Number required

Amount Lost required

Explanation of Problem required

First Name required

Last Name required

Phone required

Email required

Street Address required

City required

State required

Zip required

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