Refund Request

ONLY FOR THOSE WHO ARE ENDING THEIR RELATIONSHIP WITH THE UNIVERSITY

Print this page and present this form at Blugold Card Services.
Please print the information below.

___________________________________________________________________
ID NUMBER

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

___   Blugold Account
         Last date account will be used  _____________

___   Additional Meal Plan Dollars
         Last date account will be used  _____________

___   Diner’s Club
         Last date account will be used  _____________

I am making this formal request within one month of the date that I officially leave the University. I understand that a $15 processing fee will be taken from the accounts identified above before I receive my refund. I understand that only additional money deposited into my Meal Plan Dollar Account can be refunded.

I am aware that once Blugold Card Services 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.