Vending Refund Request

Use this form to request a refund for a vending machine malfunction. All fields are required unless marked otherwise. Refunds are limited to $5.00 per incident and must be submitted within 30 days.

Full Name Mailing Address (for check) Phone Number (optional) Date of Incident Machine Location Amount Lost Selection Attempted (if known, e.g. B4) Description of Malfunction

Refund requests are reviewed by Department staff. Fraudulent claims may result in suspension of vending privileges. The Department is not sure what that means either, but it is Village policy.