Screen Reader Mode Icon
Use this form to submit your final bill if it was not available at the point of purchase (E.G. a hotel reservation you haven't stayed at yet, or a cable service before the first month's bill).  

Question Title

* 1. Who are you?

Question Title

* 2. What is the name of the company you are purchasing from?

Question Title

* 3. What type of product did you buy?

Question Title

* 4. Upload the final bill for what you paid (Please crop or black out personal information!) 

PDF, JPEG, JPG, PNG file types only.
Choose File

Question Title

* 5. OPTIONAL: upload other context images as needed (third party seller screen shot, other context) 

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

Question Title

* 6. When did you get this final image?

Date
Time

Question Title

* 7. Were there any fees here that were not reported on the first form?

Question Title

* 8. If yes, what extra fees did you find, and how much were they?  

0 of 8 answered
 

T