Billing Disputes

 

Please complete the form below

Internal reference ID allocated to the billing dispute.
Authorised Account Representative *
Authorised Account Representative
Billing Dispute Details
Product Type(s) *
Select the product type(s) relating to the dispute.
If the dispute relates to a previously submitted billing enquiry please include the previously allocated billing enquiry ID.
$
List the relevant Acurus accounts to which the disputed amounts have been invoiced.
Invoice Details
Invoice Date *
Invoice Date
Comments
Supporting Documentation *