Visa Refund - Excel

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					                              FEDERAL WAY PUBLIC SCHOOLS
                            Credit Card Authorization Form


VISA                   Mastercard                                         Refund

Account Number

Expiration Date (MM/YY) _____________

Billing Street Address ______________________________________            Zip Code

Phone Number       (____________)_______________________

Name as it Appears on the Credit Card:

        If Requested by Phone:
                                         (Print Name)

        If Requested in Writing:
        OR                               (Signature of Person Authorizing Charge)
        Attach Written Authorization

Student Name:      ___________________________             ID #: ______________

Item                                                           Account Number                  Amount
MAY ALSO ATTACH FEE SHEET                                                                 $
                                                                               Grand Total $

For Office Use Only:

Approval Number:                                        Approval Date:

Processed By:                                            GF: $              ASB: $

Description: Visa Refund document sample