Request for Printing Refund

To get a refund, this form must be filled out completely.

1 Start 2 Complete

Full Name *

Cal Poly Email Address *

Print Date *

Print Time (e.g., 10:46 am) *

List Item(s) Printed (e.g., PDF File, Word Doc, etc.) *

Description, file name, file type or web site you printed.

Printer Number *

Located on the top-right front of the printer (e.g, PhrsPrinterXX)

Total Number of Pages of Print Job *

Number of Print Job(s) for refund *

Total Dollar Amount of Print Job *

Reason for Refund *

How the job was printed:

Is the print job a PDF file *

Was the print job printed from the Chrome browser? *

Was job printed from a Cal Poly Computer? *

Lab Monitor *

Number of pages for refund

Dollar amount of partial refund requested

I hereby acknowledge that all of the above information is true and accurate *

Yes

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