Food & Nutrition Services
Refund Request Form
 
PAYEE NAME*

AMOUNT $

(Leave blank if unknown)
STUDENT NUMBER

STUDENT NAME*

SCHOOL NAME*

PAYEE ADDRESS*

Phone:*

CITY*

STATE

ZIP*

REASON FOR REFUND REQUEST

Please select what you would like us to do with the money left in your account. If no box is checked, then a check will be sent to the payee at the address listed above.
 
FULL REFUND TRANSFERRED TO:

STUDENT`S NAME

SCHOOL NAME*

STUDENT NUMBER

or birthday if ID is unknown
 
FULL REFUND ISSUED TO THE PAYEE AT THE ADDRESS LISTED ABOVE

 
DONATE TO SCHOOL (To support students who need assistance paying for school meals)

By checking the box below you acknowledge that Autopay with My Payments Plus has been turned off for this student or that it is not applicable.
 
Autopay on My Payments Plus is turned off or this is Not Applicable*

Full refunds will be issued in 4-6 weeks. Transfer and donation requests will be processed within 48 hours of receipt. Once completed, use the submit button below. Contact Food & Nutrition Services at 425-385-4380 or email foodservices@everettsd.org for questions.
FOR FOOD & NUTRITION AND ACCOUNTING USE ONLY
ACCOUNT CODE (BUDGET)

ORIGINAL RECEIPT (R #)*

RECEIVED BY

DATE

AUTHORIZED BY

DATE

ACCOUNTING NOTES

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