Printer Error Refund Application

All answers are mandatory unless otherwise noted.

Name*
First Last
Student/Staff/Guest Card Number*
Carleton Email*
Building*
Floor Number*
Print Job Sent From*
Transaction Date*
Date Format: MM slash DD slash YYYY
Transaction Time*

: HH

MM
Amount of Transaction ($)*
Amount in CAD$
Number of Pages*
Choose all that apply*
- Print/Copy Single Sided
- Print/Copy Double Sided
- Colour
- Scan
What was the error?*
*
- I am aware that funds will be deposited to the card provided above. I understand that staff of the Campus Card Office will investigate this request and funds will only be deposited if an error can be verified.
Additional Comments

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