Refund Tracker Form
Request Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
First Name
Last Name
Email
example@example.com
Username
Payment Gateway
Stripe
Fastspring
Adyen
Paypal
Bluesnap
Paypal email
example@example.com
Is the refund request within the 30-day money-back guarantee period?
Yes
No
Please select the refund reason
No reason provided
Not using it
Using another tool
Not satisfied
Additional/extra charge
Other
Please specify
Product Name
Product ID
When did you buy the product?
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rows
Yes
No
Do you have the invoice?
1
2
Have you read the refund policy?
3
4
Based on the refund policy, are you eligible for a refund?
5
6
Requested Amount
Currency
Please Select
USD
EUR
Additional Notes
Please upload related screenshots (if necessary)
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