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Refund Request Form

Please complete to request a refund for a program, permit or membership. For assistance or general questions about refunds, email Recreation Services or call 613-389-3648.

Please allow up to 48 business hours for a response to your request. Cheque refunds can take up to 4-6 weeks to be processed.

Notice of Collection

Personal information on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c. 25, as amended, to administer refunds for Loyalist Township. Questions about this collection should be directed to:

Administrative & Customer Service Coordinator
Community & Customer Services Department
P.O. Box 70, 263 Main Street
Odessa, Ontario K0H 2H0 or by contacting Recreation Services

Alternate formats of this form are available by contacting Facility Booking.

Refund by:

Cheque

Card Payment (Visa, Mastercard, Visa Debit)

First Name:

Last Name:

Address:

City:

Postal Code:

Email Address:

Phone Number:

Type of Refund:

Name of Activity:

Client Name:

Explanation (attach original receipt and if applicable any other documentation as requested):

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Customer Name:

Date (MM/dd/yyyy):

Signature:

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