[Date]
[Your Name]
[Your Address]
[City, State, ZIP Code]
Dear [Recipient],
I am requesting a refund for [Product or Service] purchased on [Date].
The reason for the request is [Reason for Refund]. I have included any details or documentation that may help with your review.
Please let me know what else is needed to process the refund.
Sincerely,
[Your Name]