Refund Request

1
Payment Method* This field is required.
Credit/Debit Card
Cash
Google Pay
Apple Pay
2
Before you proceed; please look at the top right corner of the kiosk screen.
3
Did you see credits available?* This field is required.
YESNO
4
We are sorry to hear that. Please continue to provide us with your personal information so our team can issue a refund.
5
Great! Please press "change" to receive a refund, or select a product and click "Place Order" to continue with the transaction.
6
Name* This field is required.
First Name
Last Name
7
Email* This field is required.
example@example.com
8
Phone Number* This field is required.
Please enter a valid phone number.
9
Please provide the Date and Time of the transaction* This field is required.
Date
Month
Day
Year
8
1
2
3
4
5
6
7
8
9
10
11
12
Hour
39
00
01
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57
58
59
Minutes
PM
AM
PM
10
Where did the issue happen? (State, City, and Name of the property)* This field is required.
11
What happened?* This field is required.Chose from the dropdown the option that best describes the issue.
Only part of my order was dispensed.
The product was damaged.
I received the wrong product.
I didn't receive my product.
12
Additional Information (optional)Please provide details on the issue. What products were you trying to purchase? Did the machine show any messages on the screen? This feedback is optional and it helps us to improve our service.
13
Please provide the last 4 digits of the card used.* This field is required.
14
Select a refund method.* This field is required.
Zelle
CashApp
Paypal
Venmo
15
Please provide the username/email/phone associated with your {typeA20} account.* This field is required.
16
Please attach a picture of the issue (optional).
Drag and drop files here
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