REFUND REQUEST

Form Instructions:

1. Enter the payee's full name and address
2. Enter a reason for the refund request
3. Table (a header row, six columns, and five rows for data entry)
   • Column 1 - Enter the Department Reference Number
   • Column 2 - Enter the Business Area Number
   • Column 3 - Select the Cost Object Type from the drop-down list. Options include:
     • Cost Center
     • Internal Order
     • Work Breakdown Structure
   • Column 4 - Enter the Cost Object Number
   • Column 5 - Enter the Cost Object Name
   • Column 6 - Enter the amount to be charged to the Cost Object
   • Total - This is a calculated field. No entry necessary
4. Enter the name of the individual authorizing the refund
5. Enter the title of the individual authorizing the refund
6. The authorizing individual must provide either a hand-written signature or their digital ID
7. If the authorizing individual provided a hand-written signature, enter the date the form was signed. If a digital ID provided, skip this field
8. Enter the name of the Business Area
9. If refund is payable by check, indicate if the check is to be mailed or held by checking the appropriate box. Held checks are available for pick-up in the Accounting Operations office