Refund agreement

Before we send the agreed refund, we must recieve this signed form as acceptance of the agreed refund.

Your Name(Required)

First Last

This is the name of the person dealing with the refund.

Customer Name(Required)

First Last

This is the name of the customer on the booking.

Pupil reference number(Required)

Eg, P000000

Todays date(Required)

Customer Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Your email address(Required)

Amount agreed for refund(Required)

This is the amount that has been agreed

Bank sort code(Required)

Bank account number(Required)

Full name on bank account(Required)

This MUST be identical to how it appears on your statements.

Signature(Required)

By signing and submitting this form you are confirming you agree to the amount disclosed on this form as the final settlement on this account and no further attempts to claim further money back will be made by any means, including a bank chargeback.