Refund Request Form
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Request Date
*
-
Month
-
Day
Year
Date
Time of Incident
*
Hour Minutes
AM
PM
AM/PM Option
Location of Machine
*
Please Select
Ang Mo Kio ITE
Bukit Batok Civil Service Club (Left Machine)
Bukit Batok Civil Service Club (Middle Machine)
Bukit Batok Civil Service Club (Right Machine)
Bukit Panjang Plaza Taxi Stand
Burlington Square
Casa Rosa Condo
CJ Koh Law Library
Clementi Mall (left Machine)
Clementi Mall (right Machine)
Delta House
Dou Tian Gong Temple (Glass Machine)
Dou Tian Gong Temple (No Glass)
GB Building
IMM
Jcube Lvl 2
Jcube Lvl 3
Lasalle College Of The Arts
LG service centre (Beside Now Comms Asia)
Lot 1 mall
Luve Avenue Studio
National Museum
Nets Office
NUS Blk AS6
NUS Blk E3A
NUS Blk S1A
NUS College of Alice & Peter Tan
NUS Faculty Of Law Lvl 3
NUS Faculty Of Law Lvl 5
NUS Ridge View Tower
NUS Shaw Foundation Alumni House
NUS Sheares Hall
NUS Yusof Ishak House
Phoenix Park
Radin Mass Community Centre
Raeburn Park (Big Machine)
Raeburn Park (Small Machine)
Redhill Temple
Richzone properties Investment Blk 991 (Between Gym & Toilet)
Rochester Mall
Summerhill Condo (Basement)
Summerhill Condo (Beside toilet)
Tanjong Katong (Beside Bus stop)
Tekka Place
The Octagon
Tuas Vista
Underground Recording Studio
Westway (Big Machine)
Westway (Small Machine)
Woodlands Accessories
Woodlands Temple
World Scientific Publishing Co
Yale-NUS College
Other
Other Location
Please indicate location if you selected "Other"
Reason for Refund
*
No change is given
Machine did not dispense the item
Other
Mode of Payment
*
Apple Pay
Credit Card
Google Pay
Nets
Cash
Other
Refund Amount ($)
*
Please upload a relevant image of the Vending Machine
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Preferred mode of Refund
*
PayNow
PayLah!
Other
Additional Remark
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