Vending Machine Suggestion or Refund Request

VENDING MACHINE SUGGESTION/REFUND REQUEST FORM

Please use this form to submit any suggestions for improvement or to request a refund due to a malfunctioning vending machine. We value your feedback and will process refund requests promptly.

SECTION 1: CUSTOMER INFORMATION

Name(Required)

First Last

Email(Required)

Phone(Required)

Date(Required)

SECTION 2: LOCATION DETAILS

Location of Vending Machine:(Required)

Vending Machine ID

SECTION 3: REASON FOR CONTACT (Please check all that apply)

Suggestion

Description of your suggestion

Date of Purchase

Time

Time of Purchase

Product Name

Amount Paid

Describe the malfunction

(e.g., product stuck, incorrect item dispensed, machine error)

SECTION 4: REFUND INFORMATION

(For refund requests only)

Untitled

Cash (available at the service desk or through an authorized representative)

SECTION 5: ADDITIONAL COMMENTS

Additional Comments/Feedback

Signature