Cancellation request
Please note that only orders of item is eligible for cancellation if request is submitted on or before 5:00PM on the same day it is placed.

If payment was made thru Credit/Debit card, GCash or Paypal, please indicate N/A under the bank details.

If other mode of payment was made, please indicate bank details as refund will be directly deposited to your bank.

Refunds will be processed within five (5) working days from the date of submission of this form.
Sign in to Google to save your progress. Learn more
Email *
Order Number: *
Reason for requesting cancellation: *
Bank name: *
Name in bank: *
Account number: *
Other remarks:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of ASIAN EYE INSTITUTE. Report Abuse