Billing Disputes

Company Name

Customer Reference ID

Internal reference ID allocated to the billing dispute.

Authorised Account Representative

First Name

Last Name

Phone

Email Address

Billing Dispute Details

Product Type(s)

Select the product type(s) relating to the dispute.

Broadband

Voice

Other

Billing Enquiry ID

If the dispute relates to a previously submitted billing enquiry please include the previously allocated billing enquiry ID.

Disputed Amount (Ex. GST)

$

Acurus Account Number(s)

List the relevant Acurus accounts to which the disputed amounts have been invoiced.

Invoice Details

Invoice Date

MM

DD

YYYY

Invoice Number

Comments

Subject

Description

Supporting Documentation

I will attach any supporting documentation to an email sent to accounts@acurus.com.au.