Blugold Account Refund Request form

(Only for students who are leaving the University)

Please print this page, fill it out, and return it to the Blugold Card Office, Davies Center 156.

Name (print): _______________________________________

ID Number: ________________________________________

I attest that I am not returning to the University of Wisconsin-Eau Claire for next term and am requesting that my remaining dollars (must have at least $25 in the account) be refunded from the following accounts:

____ Blugold Account

• Last Day Blugold account will be used _____________

____ Additional Meal Plan dollars

• Last Day Meal Plan will be used ___________________

____ Diner’s Club

• Last Day Diner’s Club will be used_________________

I am making this formal request within one month of the time that I officially leave the University. I understand that a $15.00 processing fee will be taken from the accounts mentioned above before I receive my refund. I understand that only additional money deposited into my Meal Plan can be refunded.

I am aware that once the Blugold Card Office and the University Business Office have determined that I do not owe the university money, I will receive my refund in the form of a check from the Business Office. If I owe money, my account balance will be applied to this debt. This process will be complete from 24 hours to one month after the request is made.

Signature: ______________________________________________________

Date: ___________________________________