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Refund Request
Important:
Submitting this form does
not
approve or issue a refund. All refunds must be reviewed and approved by the main office. This form sends the request to the office for review.
Who & Where
Salesperson requesting the refund
*
— Select —
Elizabeth Melgar
Ray Cato
Kafui Ablordeppey
Kevorick Jones
Robert Deering
Alexia Taylor
Cheyanne Taylor
Nikki Taylor
Other
If other, enter name
*
Store location
*
— Select store —
Arlington
Cedar Hills
Mayport
Phillips
Tallahassee
Customer
Customer name
*
Customer phone
*
Customer email
Purchase & Item
Date of purchase
*
Invoice number
*
Item being refunded
*
Appliance type, brand/model if known.
Original payment method
*
— Select —
Credit/Debit Card
Cash
Check
Financing
Rent-to-Own
Other
Is the appliance being returned?
*
— Select —
Yes - full return
No - keeping the item
Partial / exchange
Refund Details
Refund amount requested
*
Refund method requested
*
— Select —
Back to original card
Cash
Check
Store credit
Other
Reason for the refund
*
Has the customer been informed of the 20% restocking fee?
*
— Select —
Yes — customer acknowledged the 20% fee
No — not yet discussed
N/A — no restocking fee applies
Item price (pre-tax)
*
Sales tax collected
Item price (pre-tax):
$0.00
Less 20% restocking fee:
−$0.00
Item after fee:
$0.00
Sales tax collected:
$0.00
⚠ This is a reference breakdown only. The office (Nikki) confirms the final refund amount, including how tax is handled.
Documentation / photos available?
No
Yes
If yes, please text or email the photos to the office along with this request — note that below.
Documentation notes
Additional notes
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