Mobile Wallet SMS Alert Charges Refund Request Form
Use this form to request a refund for SMS alert charges linked to your mobile wallet and provide the details needed to review your claim.
Refund Request Details
Full Name
*
First Name
Middle Name
Last Name
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Mobile Wallet Provider
*
Wallet Reference or Partial Identifier
*
Date of SMS Charge
*
-
Month
-
Day
Year
Date
SMS Alert Charge Amount
*
Number of Charged SMS Alerts
*
Transaction or Reference Number
Reason for Refund Request
*
Duplicate charge
Service not received
Unauthorized alert
Incorrect billing
Other
If Other, Please Explain
Charge Evidence and Context
Date range of affected SMS alerts
*
-
Month
-
Day
Year
Date
Phone number the alerts were sent to
*
Please enter a valid phone number.
Format: (000) 000-0000.
SMS alert content or sender name
*
Supporting evidence (screenshots, billing statements, or message logs)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional details to verify the claim
Refund Handling Preferences
Preferred refund handling
*
Refund to wallet balance
Reverse the SMS alert fee
Credit to next wallet bill
Contact me for manual review
Preferred contact method for follow-up
*
Please Select
Email
Phone
Text message
No follow-up needed
Declaration
*
I confirm the details provided are accurate
I confirm the charges are related to my wallet
I understand this request may require verification before approval
Review note
Submit Refund Request
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