PERALTA COMMUNITY COLLEGE DISTRICT/BERKELEY CITY COLLEGE REFUND REQUEST FORM
To be completed by student:
For Official Use Only
Name:
Refundfor:TermYear
Student ID#
Studen tPaidby:
Address
Cash$_____________
City State Zip
Che ck$____________
Phone ( )
CreditCard$___________CR#___________
email address:
CreditCardMailPickup Le ss:Proce ssingFee:$___________
RefundProcedure:
Paymentsmadebycreditcard/onlinewil l beref und edback
tothecreditcardusedforpayment.Refundcheckwill be
i ssuedforpaymentsmadebycash,ch
eck/onlineE‐Che ck.
Note:Refundoftuiti onpaidbyabusine ss, trust,government
agency,militaryinstallation,etc,wi l l bereturnedtothe
organizationunl essotherwisestatedbythePaye e .
IfALLClassesareDropped:Therewillbea$10.00servic echargefor
proc essingfee.
Ple aseallow4to6weeksafterlastdaytoaddcl a ssesforprocessing.
TOTAL NET REFUND
$_____________
StudentSignature: Date RefundProce ssby :Date
Refund by:
Check#_______ $ _______
CreditCard#________ $______
click to sign
signature
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