Request for Billing Review
Name
First Name
Last Name
Contact E-Mail
example@example.com
Case Submission
To request a refund or credit, please detail your case below and our billing department will review your submission. You will receive a case response via e-mail, typically within 3 business days. Please be advised that making a claim does not guarantee that a credit or refund will be offered.
Website URL
www.example.com
Request for Billing Review :
*
Please provide as much detail as possible including what products you are making a claim for.
Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: