Get Billing Dispute Notification Form For Centrally Billed ... - Jefferson Lab - Jlab

Filing a billing dispute can be an essential step in managing your accounts effectively. This guide provides you with clear instructions on how to fill out the Billing Dispute Notification Form for Centrally Billed Accounts at Jefferson Lab to ensure a smooth and efficient process.

Follow the steps to complete the Billing Dispute Notification Form.

1. Press the ‘Get Form’ button to obtain the Billing Dispute Notification Form and launch it in your chosen editing platform.
2. In Section 1, enter the agency or organization name associated with your central account. Input your 16-digit Central Account Number and your Transaction Account Number. Although the Invoice Number is marked as N/A, ensure to include the Statement Date, which indicates when the billing statement was generated.
3. Move on to Section 2, where you will provide details about the transaction. Fill out the Reference Number for the disputed item, the Dollar Amount in question, as well as the Transaction Date and Posting Date. Specify both the Ticket Number and Vendor Name relevant to the transaction.
4. Select a Reason Code that best represents the dispute or billing inquiry. For disputes, use codes A through D, and include details in Section 3 if necessary.
5. In Section 3, provide any remarks that will assist in resolving your dispute or inquiry. Include all relevant dates and summaries of communication with merchants.
6. Finally, complete Section 4 by providing the name and authorized signature of the person initiating the dispute. Include their contact information, ensuring that area or country codes are accurate.
7. After filling out the form, review all information for accuracy. Then, you can save the changes, download, print, or share the completed form as required.

Take action now by filling out your Billing Dispute Notification Form online.