Refund Form - Huntington Beach Adult School
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1REQUEST FOR REFUND/CREDIT
17231 Gothard Street, Huntington Beach, CA 92647
Phone: (714) 842-4227
Fax: (714) 847-8316
STUDENT NAME:
ID #:
DATE:
PREFERRED PHONE #:
OTHER PHONE #:
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)
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)
REFUND POLICY:
No refunds will be made to students who withdraw unless a written request with the receipt
attached is received by the Adult School no later than three working days before the class begins (unless an
earlier date is specified in the class description for a class requiring guaranteed enrollment to be held). A $20
processing fee will be charged per request for refund (max 3 classes) except for classes cancelled by the
Adult School. Please allow 2-4 weeks for refunds to be processed.
AMOUNT
COURSE TITLE
SECTION #
SESSION DATE
DAY
TIME
PAID
1
2
3
Please circle the method of payment. If you paid with a credit card, that same credit card
number must be indicated below.
Cash
Check
Money Order
VISA
MasterCard
Credit Card #: _____ _____ _____ _____ - _____ _____ _____ _____ - _____ _____ _____ _____ - _____ _____ _____ _____
Expiration Date: ___________________
Cardholder Name: _______________________________________
REASON FOR REQUEST:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
FOR OFFICE USE ONLY
ADMINISTRATOR SIGNATURE:
Full Refund Approved: _______________________________________________
Date: _______________
Refund less $20 registration fee
Approved: _______________________
Date: _______________
Refund Denied: ____________________________________________________
Date: _______________
Credit Towards a Future Class:_________________________________________
Date: _______________
Revised: 07/16/12
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Parent category: Business