REFUND RECEIPT

Date: ___________________________
Receipt number: __________________

Customer Information
Name: _________________________________
Address: _______________________________
Phone: ________________________________

Item Description Quantity Price Subtotal

Total item(s) refunded: _________

Subtotal: _________
Tax: _________
Grand total refunded: _________

Refund method: ☐ Check / ☐ Credit Card / ☐ Other: _______________________

Check/Card # _______________________