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Please utilize this form to request a Laundry Machine Refund for a Campus Cash transaction. If the laundry machine in question does not accept Campus Cash, or if you did not use your Campus Cash for the transaction, please do not submit this form.

If you prefer to fill your form out offline, please download a PDF version.

Note: All fields are required.

University ID Number:
First Name:
Last Name:
Daytime Phone Number: ( ) -
Your Campus Address:
Email Address:
Amount of Funds Lost:
Laundry Machine Location:
Machine Type:
Machine ID Color:
Machine ID Letter:
Machine ID Number:
Date the problem was encountered:
Approximate time the problem was encountered:
Please describe the problem: