Attention:
JavaScript is not enabled! Please enable javascript for the best experience.
Skip to Main Content.
An Official Rhode Island State Website.
Rhode Island Department of State
Nellie M. Gorbea
Secretary of State
Menu
Business Services
Elections
Civics and Education
Open Government
Search this site.
Search this site.
Refund Request Form
Payer Information
Entity/Individual Name
Entity Id
Type of Filing
Contact Information
Name
E-Mail
Verify Email
Phone
Refund Details
Reason
Please select a reason
OverPayment
Duplicate Payment
Other
Refund Amount
Confirmation/Receipt Number
Payment Type
Check
Credit Card
Cash
Check Number
Cardholder Name
Cardholder Address
Street Address
City
State
Zip Code
Attachments
?
(.jpg,.jpeg,.gif,.png,.pdf)
Refund to be issued to
Name
Address
Same as Cardholder Address
Street Address
City
State
Zip Code
Instructions to Fill Refund Request Form