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).  

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1. Who are you? (Required.)

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2. What is the name of the company you are purchasing from? (Required.)

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3. What type of product did you buy?

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

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

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6. When did you get this final image? (Required.)

Date
Time

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

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

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