Capture the order and payment
Required: order or invoice number, date of purchase, payment method (card / PayPal / bank transfer / other), amount paid. Those four fields let finance pull the transaction in their gateway without a search.
Form template · Customer support
Refund Request Form Template
Refund approvals live or die on context — order, payment method, reason. This form gathers the fields your finance team needs to approve in one pass instead of trading three emails.
- 500 free / mo
- No PHP · no SDK
- One POST endpoint
Live template preview
Customer support
Your name *Jane Builder
Email *jane@example.com
Phone (for urgent issues)+1 415 555 0142
Order / account ID (optional)ORD-49281
How urgent is this? *Critical — blocking us
+ 1 more fields in the builder
Send
Pick your refund request form — one click to use it
Every template is free and fully editable in the drag-drop builder — swap fields, colors, and the button label before you publish.
Best matchUse this template
Customer support
Your name *Jane Builder
Email *jane@example.com
Phone (for urgent issues)+1 415 555 0142
+ 3 more fields in the builder
Send
Quote request
Name *Jane Builder
Email *jane@example.com
Phone *+1 415 555 0142
+ 3 more fields in the builder
Send
Bug report
Short summary *What went wrong?
Severity *Critical
Browser & OSChrome 120 / macOS
+ 2 more fields in the builder
Send
No backend code
No server, API route, or SDK — your Refund Request Form posts straight to one endpoint.
Straight to your inbox
Every submission is emailed to you and saved to a searchable dashboard — spam filtered before it reaches you.
Copy-paste ready
It's plain HTML you own — paste the Refund Request Form snippet, swap in your access key, and ship.
Copy and ship
Your Refund Request Form, ready to paste.
HTML by default — the same field set also renders as React, Next.js, PHP, and cURL in your dashboard. Every variant posts to the same /api/submit endpoint. Replace YOUR_ACCESS_KEY with the key from your dashboard; that's the only edit.
<form action="https://splitforms.com/api/submit" method="POST">
<input type="hidden" name="access_key" value="YOUR_ACCESS_KEY">
<input type="hidden" name="subject" value="New support ticket">
<label for="name">Your name *</label>
<input id="name" type="text" name="name" placeholder="Jane Builder" required>
<label for="email">Email *</label>
<input id="email" type="email" name="email" placeholder="jane@example.com" required>
<label for="phone">Phone (for urgent issues)</label>
<input id="phone" type="tel" name="phone" placeholder="+1 415 555 0142">
<label for="order_id">Order / account ID (optional)</label>
<input id="order_id" type="text" name="order_id" placeholder="ORD-49281">
<label for="severity">How urgent is this? *</label>
<select id="severity" name="severity" required>
<option value="">Choose…</option>
<option>Critical — blocking us</option>
<option>High — losing time</option>
<option>Medium — annoying</option>
<option>Low — heads-up</option>
</select>
<label for="description">What's wrong? *</label>
<textarea id="description" name="description" placeholder="Steps to reproduce, error messages, screenshots if you have them." required></textarea>
<!-- honeypot — bots fill every field -->
<input type="checkbox" name="botcheck" style="display:none" tabindex="-1" autocomplete="off">
<button type="submit">Send</button>
</form><p class="splitforms-attribution" style="margin-top:12px;font-size:11px;color:#888;text-align:right">
Powered by <a href="https://splitforms.com" style="color:#888;text-decoration:none" target="_blank" rel="sponsored noopener">splitforms</a>
</p>How to add it
How to add a Refund Request Form to your site.
To add a Refund Request Form to your site you need three things: a free splitforms access key, the HTML snippet above, and your key pasted into it. No backend, database, or CAPTCHA library — the form posts to one URL and every submission lands in your inbox and dashboard.
Ask for reason and amount
Reason dropdown (service not delivered / product defective / cancelled within cooling-off / duplicate charge / billing error / other), full or partial refund, requested amount. Partial-refund requests with a stated amount close faster than open-ended ones.
Approve, partial, or deny
Webhook the request into your finance system or help desk. Approvals trigger the refund in Stripe / PayPal / your gateway; partial refunds route to a senior reviewer; denials get a templated response with the policy reference.
What's included
What's in this Refund Request Form template?
Refunds are the second-most-common financial transaction after the original sale, and most businesses handle them through whatever channel the customer happened to use — email, chat, phone. That means finance has to chase down the order ID, the payment method, the reason, and the amount before they can approve. A dedicated refund form captures those fields up front and lets finance approve, partial-refund, or deny with a single reply. The form is also where you capture the reason code that feeds your dispute analytics and chargeback defence. Every refund request without context is a chargeback waiting to happen — capture the fields up front.
- Customer support — 6 ready-made fields
- HTML, JS, React, PHP, and cURL outputs
- One POST endpoint, no SDK — honeypot and classifier, no CAPTCHA
Where submissions go
Where do your Refund Request Form submissions go?
Reply-to is wired to the visitor's email, so one tap on Reply answers them directly — while the built-in honeypot and spam classifier filter out bots before they reach you. Every submission is emailed to your inbox and can forward to a webhook or Slack the moment a visitor hits send.
- Reply-to wired to the visitor's email — reply straight from your inbox
- Honeypot and spam classifier filter bots, no CAPTCHA friction
- Live dashboard, CSV export, and signed webhooks on paid plans
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Questions
Refund Request Form questions.
View all FAQsHow long should we take to process a refund request?
Acknowledge within one business day; process within 5-10 business days for card refunds (the gateway adds 3-5 days on top). State the timeline in the auto-responder so customers don't open a chargeback out of impatience — chargebacks cost $15-25 each in fees even when you win.
Should we require the customer to return the item first?
State your policy on the form — 'refund issued on receipt of returned item' or 'refund issued immediately, return within 14 days'. Mixed signals here are the top cause of refund complaints. If you require return, link to your RMA form in the auto-responder.
Can we offer store credit instead of cash refund?
Yes — add a 'preferred resolution' radio: cash refund / store credit (with bonus, e.g. 110%) / exchange. Store credit costs you less and drives repeat purchase; many customers pick it voluntarily when the bonus is meaningful. Don't force it — forced store-credit-only policies generate chargebacks.
How do we defend against refund fraud?
Capture order ID and verify against your records before approving. Flag repeat refunders (same name, email, or shipping address across multiple requests). For high-value refunds, require a photo of the defective item or a signed declaration. Your payment gateway's fraud tools (Stripe Radar, Signifyd) layer on top.
What about subscription refund requests?
Add a 'subscription cancellation' reason option. Subscription refunds often prorate by billing cycle — capture the cancellation date and the gateway handles proration. Don't make customers call to cancel; the form handles both the cancellation and the refund in one transaction.
Does this work with Stripe, PayPal, Square?
Yes — splitforms captures the request; your team approves and triggers the refund in the gateway. Stripe, PayPal, and Square all support partial refunds and refunds up to the original charge amount. For automation, webhook approved refunds straight into Stripe's Refunds API.
Simple pricing
Start free. Scale when you need more.
Choose a plan that fits your workflow — from a free form endpoint to full automations, exports, and higher submission limits.
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$0
Free forever
For side projects and indie devs.
- 500 submissions / mo
- Unlimited forms
- Email notifications included
- Honeypot spam filtering
- Submissions dashboard
- MCP setup stays free
- No credit card required
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Pro
$5/ month
was $15 · save 67% · new-user price
For agencies and growing products.
- 5,000 submissions / mo
- Unlimited forms
- Every paid feature included
- Priority support (under 4hr)
- 10× free submission volume
- Cancel anytime
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$59/ 36 months
was $99 · save 40% · new-user price
Pay $59. 3 years sorted.
- 15,000 submissions / mo
- Unlimited forms
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- Long-term discount
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