Report a payment discrepancy

1
Original PO/Order Number* This field is required.
2
Date of PO/Order (Optional)
Date
Year
Month
Day
3
Name on the PO/Order* This field is required.
First Name
Last Name
4
Email* This field is required.
example@example.com
5
Phone Number* This field is required.Phone associated with this order
Area Code
Phone Number
6
Have you been Invoiced yet?
YESNO
7
Invoice Number
8
Dollar Amount of discrepancy* This field is required.
9
Reason/Notes* This field is required.Reason or Notes on discrepancy details [ entire order, or line items ]
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: