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You are here: Home > Housing Services > Documents & Forms > Soda & Snack Refund Request

Soda & Snack Refund Request

First Name (Required)

Last Name (Required)

Student ID Number (Required)

Phone Number (Required)

E-Mail Address (Required)

Mailing Address (Required)

Dollar Amount (Required)

Type of Transaction/Malfunction (Required)

Titan Card ( ALL refunds will be credited to your Titan Dollars and you will be notified by email )
Gift Card
Cash

Cash or Gift Card Refund (Required)

I agree to receive my refund by:

Credit to my Titans Dollars and be notified by email
Cash - I will contact Titan Central upon receipt of email notification to make arrangements to obtain refund. After 30 days money will be forfeited.

Gift Card Number

If gift card was selected above otherwise N/A

Date and Time of Problem (Required)

/ /

:

Machine Type (Required)

Pepsi - Bottle ( Soda, Water, Frapuchino, Energy Drink, Gatorade, Juice )
Pepsi - Can
Canteen Snack ( Candy, Chips, Gum )

Building (Required)

Location (Required)

Lobby
Basement
Lounge
Floor

What Floor?

Problem (Required)

Took money - did not vend
Stale or opened product
Not accepting coins
Not accepting bills
Product stuck in machine
Did not give correct change

Comments (Required)

Detail explanation

by puckhb85 — last modified Mar 12, 2009 01:20 PM

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