Username of the person completing this form:

Username of the person needing a refund:

Job Submitted From:

Location:

Date Printed:

Time Printed:

Enter the time that My Print Center says the job was printed. If multiple jobs in a row need refunded, enter the time of the first job.

Number of jobs that need a refund:

How many jobs does the user need refunded for?

Dollar Amount of print job, listed on My Print Center (print.pitt.edu).

Enter the dollar amount for the print job. If multiple jobs in a row need refunded, enter the total dollar amount for all jobs.

Print Type:

How many Sheets actually printed:

How many Sheets were returned:

If any sheets printed that need to be refunded, they must be returned to Cathedral G62 Computing Lab.

Reason with details on what happen and how many sheets need refunded:

List as much detail as possible.

Attachment

Optional: attach the file with the issue.