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Questionnaire template

Billing Complaint Form

Captures a customer's billing problem, disputed amount, earlier contact and desired resolution for the billing team.

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Other · Complaint forms. All Other templates

Questions in this template

Your Account

  1. If you think something on your bill is wrong, tell us here. The more detail you give, the faster we can look into it and put it right.

  2. Is this a personal or a business account?

    Choose one:

    • Personal
    • Business

  3. Your account number or the invoice number

    Open answer

  4. Which bill does your complaint concern?

    Choose one from a list:

    • My latest bill
    • The bill before that
    • A bill from two to three months ago
    • A bill older than three months

The Problem

  1. What is wrong with the bill? Select all that apply.

    Choose any that apply:

    • The amount is higher than I expected
    • I was charged for something I did not order or use
    • I was charged twice
    • A payment I made is not shown
    • A refund I was promised has not arrived
    • A discount or promotion was not applied
    • The invoice is missing or hard to understand
    • Other

  2. Please describe the other problem.

    Condition: Shown when Other was selected

    Open answer

  3. Roughly how much money is in dispute? Enter a whole number in your billing currency.

    A number from 0 to 1000000

  4. Please explain what happened, including any dates that matter.

    Open answer

Earlier Contact

  1. Have you already raised this problem with us?

    Choose one:

    • Yes
    • No

  2. How many times have you contacted us about it?

    Condition: Shown when the problem was raised before

    Choose one:

    • Once
    • Two or three times
    • More than three times

  3. How satisfied are you with how we dealt with it so far?

    Condition: Shown when the problem was raised before

    Choose one:

    • Very dissatisfied
    • Dissatisfied
    • Neutral
    • Satisfied
    • Very satisfied

Putting It Right

  1. What outcome would you like?

    Choose one:

    • A refund to my original payment method
    • A credit on my account
    • A corrected invoice
    • An explanation of the charge
    • Cancellation of the service
    • Other

  2. Please describe the outcome you would like.

    Condition: Shown when Other was chosen

    Open answer

  3. How should we send you our response?

    Choose one:

    • Email
    • Phone
    • Post