Request for Lunch Account Refund

 

Fill Out This Form To Submit Your Request

If you are registered on PushCoin, please confirm that your auto pay is turned off on your account before requesting a refund. If the auto pay is not turned off, a payment will automatically be added to the account when it hits zero.

Parent Email:  
 

Student's School:

Student's Full First And Last Name:  

Student ID:

Reason for request:

Amount of refund:

Name to whom check should be made:  

Address to where check should be sent:

Phone #:

Have you turned off auto pay on this account on PushCoin?

Would you like to request that the district turn off auto pay from this account?