Refund Risk Assessment Form
Refund Risk Assessment Form
Order Reference or Ticket Number
*
Refund Request Reason
*
Please Select
Product not as described
Product arrived late
Service not delivered
Duplicate charge
Other
How long after purchase was the refund requested?
*
Please Select
Within 7 days
8-30 days
31-60 days
More than 60 days
Customer History
*
Rows
Yes
No
Previous refund requests
1
2
Account flagged for risk
3
4
High value customer
5
6
Was the product/service used or accessed?
*
Yes
No
Unknown
Order Value Range
*
Please Select
Under $50
$50 - $200
$200 - $1000
Over $1000
Supporting Documentation Provided?
*
Yes
No
Not Applicable
Potential Risk Factors (Select all that apply)
Unusual order pattern
Recent account creation
High refund frequency
Discrepant contact information
Other
Overall Refund Risk Level
*
1
2
3
4
5
Reviewer Notes & Assessment
Submit Assessment
Should be Empty: