F&BS 18/10/06
Finance & Business Services, Building 10C

Bank.Rec@anu.edu.au
Enquiries:  (02) 6125 8721    
Facsimile:  (02) 6125 8797	

Request for Credit Card (Eftpos Payment) Refund	

Campus ID:		POS No:	

	Receipt No:		
Receipt Amount:	$	Refund Amount:	$	
Receipt Date:		Receipt Description:		

Library:		Refund date:		
Cardholder Name:		
Reason for Refund:		

Processed by:		
Business Unit:		Phone:		

I hereby confirm that I have supervisor delegation and authorise this refund.
	
Authorisation
(Supervisor Approval)

		
Name 
(Block Letters)		
Uni ID:		Date:		
Note: Refund authorisation must be signed by approving supervisor prior to forwarding form to DOI	

F&BS Use Only	

Refund Amount:		Date Refund Processed:		
Receipt ID:				
Operator ID:		Operator Signature:		
Comments:		
		
Please attach receipt supporting this form and forward to DOI Finance, Leonard Huxley Building 56