For Palm Beach State College Office Use Only.
PantherCard Information:
Funds remaining: $ Eligible for refund? Yes No
Balance statement printed, showing remaining funds for refund.
Post-to-maintain receipt printed, showing balance reduced to $0.00.
Customer account frozen.
Staff signature: Date:
Bursar Information:
Does student owe monies to the College? Yes No
Describe monies owed:
Will student receive a refund? Yes No
Amount to be refunded by check: $
Staff signature: Date:
PantherCard Funds Refund Request
According to Cardholder Terms & Conditions, upon complete withdrawal from the institution, the
cardholder may request his/her account be closed. The request must be in writing to the PantherCard
Office. Refunds will first be applied to any financial obligations the student has to Palm Beach State
College. Any remaining funds will be issued in the form of a check mailed to the student’s address (or via
direct deposit if student has a bank account on file with the College).
First Name: Last Name:
Student ID #: PantherCard #:
Address:
City: State: Zip:
Reason for Refund Request:
Refund Request can be submitted by mail or fax:
Palm Beach State College PantherCard Office
4200 Congress Ave. MS #61
Lake Worth, FL 33461
PantherCard@Palmbeachstate.edu
FAX: 561-868-3859
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