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VENDING SERVICE OR REFUND REQUEST

This form is for our local vending service customers.

Please select one of these options.

If you need service we will put you on our 'hot sheet'.
If you need a refund just tell us how much you lost and we will refund you money with no hassles. (If you can, please tell us which selection malfunctioned so that we may repair it.) Thank you.

Type the characters you see in this picture. (verify using audio)
Type the characters you see in the picture above; if you can't read them, submit the form and a new image will be generated. Not case sensitive.


by Dr. Radut & Smokers Association