Bearcat Card Refund

Note:

This form works best in Mozilla Firefox and Google Chrome.
VTS Location?

TUC Langsam Library CARE/Crawley
Reason for Refund: *

Withdrawing from University Graduating from University Ending employment/University Retirement
Amount of Refund Requested (USD) *
UC ID # *
Full Name: *

First Name Last Name
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email: *
example@example.com
Phone Number: *

Area Code Phone Number
Terms & Conditions: uc.edu/bearcatcard/terms-and-conditions
In Agreement? *

I agree to the terms and conditions of the Bearcat Card I do not agree to the terms and conditions of the Bearcat Card
Direct Deposit Requirement? *

I have enrolled in direct deposit.
To learn more about the Refund Direct Deposit Process, click here.
Request Date: *

Month Day Year
Additional comments?
Balance:
Balance due?
Refund Resolved:

Month Day Year
Check Bearcat Card Deposit?

No Yes
Trouble Call Placed

Month Day Year
Date/Time

Month Day Year Hour Minutes AM/PM Option
Upon submission, you will receive a copy of your submission via email.
Should be Empty:

Note: