University of Wisconsin - Stout

Refunds will be placed on your University ID in the form of Baseline Plus or Flexline funds. All refund requests must be submitted within 2 weeks of the loss. If you lost cash and would prefer a cash refund, do not submit this form but go to the Service Center in the Memorial Student Center for a cash refund.

* - denotes a required field

First Name*Last Name*M.I.*
ID Number*E-mail Address*
Type of Loss* Amount Lost*

 
(i.e. $1.25)
Building*
Type of Machine*
Washer/Dryer Beverage Snack
Date of Loss*Time of Loss*
Any other Explanation you would like to share (optional)