Western Kentucky University
1906 College Heights Blvd.
Bowling Green, KY 42101
Refund Voucher No.
   Check will be mailed to this address: (Complete address required)
   Address Line 1
   Address Line 2
   Check Payable To: 
Account Number:
Detail Code Index Fund Org Acct Prog Amount
Total-> $
Social Security/Id Number     
Type of Refund     
Amount Subject to Refund   $
Deduct   $
Net Amount of Refund   $
  Explanation of refund  
Check to be returned to the Student Billing & Account Services.  For Student Billing & Account Services personnel only.
  I certify that this voucher has been examined and that the proposed refund is correct.
Signed__________________________________________  Signed______________________________________
Date              Student Billing & Account ServicesDate
Department Preparing Voucher and Phone Number

Print 3 copies. Keep one copy for your file and send the other 2 copies to the Student Billing & Account Services, Potter Hall, Room 208.