Internal CCS Refund Request Form
Provide the customer and refund details for internal processing below.
Your Name
*
First Name
Last Name
Customer Name
*
First Name
Last Name
Customer Email Address
*
example@example.com
Customer Phone Number
*
Please enter a valid phone number that corresponds to customers number in OP/Quo.
Format: (000) 000-0000.
Did customer receive any type of move in discount/special/promotion?
*
Please Select
YES
NO
If yes above, please denote what discount/special/promotion was given below.
Date Secured
*
-
Month
-
Day
Year
Use admin fee and/or rent paid date. If only admin fee paid, use that date. If admin & rent were paid, use rent paid date.
Contract Move In Date
-
Month
-
Day
Year
Date
Customer Next Due Date
-
Month
-
Day
Year
Date
Customer Move Out Date
-
Month
-
Day
Year
Date
Space Number(s)
Refund Amount Requested
*
Reason for Refund
*
Additional Comments (optional)
Please list any additional details regarding the customers account and/or their interaction with us that you feel is pertinent.
Is customers credit card number & expiration date denoted in their account notes?
*
Please Select
YES
NO
Was RA and/or ADD signed?
*
Please Select
YES in person.
YES electronically.
NO
Was space left in good condition?
*
Please Select
YES
NO
Never Moved In
Submit Refund Request
Should be Empty: