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Invoice Dispute Form

If you or your company dispute the accuracy or completeness of an invoice, please complete the form below to log the invoice as a dispute. A dispute can be defined as any discrepancy or problem with the invoice/billing document that may result in delay of payment.

After reviewing the information, one of our Analysts will contact you with the results of our investigation. Please use separate forms for each dispute.

Denotes required field

* Company Name:
* Account Number:
* Submitted by:
* Email Address:
* Phone Number:
* Fax Number:
* Invoice, Order, or PO Number:
* Amount Disputed $:
Invoice Date:
* Nature of Dispute:
CFS Rep:
Comments/Notes (750 char max)