(QSSB LETTERHEAD)

(Date)       Dear ___________________,   Enclosed are forms that you may use to initiate a request for refund from ______________ (QSSB name).  The “Refund Letter from Producer to QSSB” may be used as a guide for your request.  However, the Refund Procedures must be followed and a request returned to this QSSB before your request can be fulfilled.   Mail your request for refund to:   (QSSB Address)