(User Name / Email Address), and my physical address is (Complete Address Contact Address from Account). I hereby affirm that the following Securus Video Connect session(s) disconnected prematurely before I or the other party completed the session(s). I am disputing the following session(s) billed to my above referenced account: Date: Time: From: Date: Time: F.
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How to fill out the Securus Video Connect Credit Request Form online
The Securus Video Connect Credit Request Form is designed for users who wish to dispute charges related to disconnected video sessions. This guide provides step-by-step instructions on how to complete the form accurately and effectively.
Follow the steps to complete the Securus Video Connect Credit Request Form
- Press the ‘Get Form’ button to acquire the Securus Video Connect Credit Request Form and open it in your preferred tool.
- In the designated field, print your full name as the customer of record, confirming your identity.
- Enter your username or email address associated with your Securus Video Connect account in the corresponding section.
- Complete the physical address field with your contact address as listed in your account details.
- List the details of the video sessions that experienced premature disconnections. For each disputed session, provide the date, time, and the name of the party involved.
- Affirm your understanding of the terms regarding service interruptions due to factors outside of Securus's control and provide authorizations where necessary.
- Print your name again in the customer of record section, sign the form, and date it.
- Finally, decide how to submit your completed form. You can attach it through the designated online channel, fax it to the provided number, or mail it to the specified address.
Complete your Securus Video Connect Credit Request Form online today to ensure a smooth and effective dispute process.
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