Online Payments - Donor Refund Request

IMPORTANT NOTE: By submitting this request, you are authorizing Greater Giving to refund your donor's credit card for the entered amount. You are also authorizing Greater Giving to reduce your next weekly Online Payments deposit by the amount of the requested refund. If the refund exceeds your total next weekly Online Payments deposit, you are authorizing Greater Giving to debit your organization's bank account for the total amount refunded prior to initiating the refund transactions.

NOTE: * - Indicates required data

* Organization    
Customer ID  
* Contact First Name    
* Contact Last Name    
* Contact Phone    
* Contact Email    
* Donor First Name as Originally Submitted    
* Donor Last Name as Originally Submitted    
* Last 4 Digits of Credit Card Number    
* Amount to be Refunded    
* Approval Code    
* Original Transaction Date    
Reason for Refund (Please do not put any requests here, this text is only stored for reference)  
This relates to a dispute/chargeback (check if 'Yes')

Information collected is protected by the latest in SSL encryption, so you can submit your transaction data with confidence.