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Request a refund of money lost in one of our machines
Date of loss:
*
Name of the business where the machine is located:
*
Specific location of the machine in the building:
*
Payment made with:
*
Machine number:
Amount lost:
*
Address to send refund:
Street line 1:
*
Street line 2 (optional)
State / Province / Region
e-mail
*
Send Information
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