Name

First Name

Last Name

Phone Number

Machine Number

Please type in the four-digit machine number on the front of the machine. If you are not at the machine please let us know the location.

Do you need a refund?

How did you pay?

8. If you paid by card, please provide the last 4 digits of the long card number

This is so that we can find you on the system to refund you.

9. If payment was made via your phone i.e applepay please provide the last 4 digits of your device account number

This can be found by going into your wallet app on your phone, selecting the card you paid with, pressing the 3 dots at the top right corner and your ‘device account number’ should then be displayed.

Description of fault

11. I have read and understood your Privacy & Cookies policy and consent to my details being stored and processed by Revive/Doozy for the purpose of this report.

Agree

Disagree