Refund or Compensation Request - As per all terms & conditions set forth, user understands any compensations determined shall not be obligated or guaranteed & shall be at the sole discretion of our Escalations Team Leadership.

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Card Holder First Name *

Card Holder Last Name *

Card Holder Valid Email Address *

RE-ENTER Card Holder Valid Email Address *

Card Holder Primary Mobile Phone Number *

County Code MUST be included and by submitting this form. You further understand and agree to receive text messages regarding this matter in the event that any emails are deemed by us to be unsuccessful or unresponsive and understand that you are solely responsible for any text messaging fees that your carrier may impose.

Card Number Issued By Your Travel Provider *

Enter the Card Number Issued By Your Travel Provider (This may be a voucher, ticket, reference or itinerary number noted on your travel documents and approved for use as a Card Number)

Travel Provider or Ticket Company *

The authorized company that issued your card to you.

Type of Card Used *

Upload Copy of Card (eCard, or Voucher) *

Upload a clear image or photo of the full front of the card issued (if a physical card) to you by your travel provider or, if issued as an eCard or iCard by your travel provider or reseller, upload the travel document page indicating issuance of the eCard or iCard corresponding to the information provided above. Travel document pages MUST clearly show the lead traveler's details, travel dates and reference/ticket/itinerary number)
Files must be less than 4 MB.
Allowed file types: gif jpg jpeg png pdf.

Did you register your Card for use in the Mobile App? *

Do you Wish to Report a Non-Compliance Event at a Participating Venue *

Name of Venue Where Alleged Non-Compliance Event Occurred *

Location Address For Venue Where Non-Compliance Event Occurred *

Must Include: Street Address, City and State to ensure an accurate investigation. (All addresses are listed in both the mobile app and web directories)

Date of Alleged Non-Compliant Event *

Month

Day

Year

Approximate Time of Alleged Non-Compliant Event *

Hour

Minute

Total Number of People in Your Party at Time of Alleged Non-Compliance Event *

Note: One one form submission permitted per valid card. If this number exceeds 4 People for a VIP Shop & Dine 4Less Card or Play 4Less Card, you must submit a subsequent form submission for each additional valid card(s). If this number exceeds 1 child 11 years or younger per qualifying adult for a Kids Eat Free Card, you must submit a subsequent form submission for each additional valid card(s).

Choose the Response that Best Fits: *

Did you speak with a supervisor or manager? *

Upload Receipt From Venue Being Reported *

As per the terms of use for all card holders, if card holder made any subsequent purchases at the venue being reported, all alleged non-compliance events must be accompanied by a receipt from the venue being reporting in order for us to conduct a full and thorough investigation. Additional information may be requested throughout our investigation. Incomplete or missing information may result in inconclusive findings and we may have to close this matter as unresolved due to missing, absent or lack of foundational information, so please be as details as possible.
Files must be less than 4 MB.
Allowed file types: gif jpg jpeg png pdf.

Please Explain the Events of Alleged Non-Compliance *

Please Be as detailed as possible so that we may conduct the most thorough of an investigation as possible. Ex: Name or description of server(s), cashier(s) and/or manager(s) that you interacted with. Explanations provided to you for non-compliance. Additional information that may be relevant to your experience at this venue. Missing details or information may result in non-findings of fact, so please be detailed and complete in providing as much information as possible so that we can follow up accordingly with the venue in question.

TYPE YOUR FULL NAME TO ACCEPT AND ACKNOWLEDGE THE FOLLOWING STATEMENT *

I (NAME TYPED BELOW), Hereby Swear and Affirm That All Information Provided Here and Previously to the Company Is True and Accurate and Understand That Submitting False Information May Be Deemed Unlawful. By Submitting this form, you hereby consent to this use of your electronic signature.

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