Economics and Finance

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Other Accounts - Disputes Form

This form should be completed by the person named on the bill. As a minimum, fields marked with a • must be completed.

• Account reference number
(you can find this number on your bill)

• Your full name

• Your full address and Postcode

Address to which the query relates to if different to above

Reason For Dispute
(please explain why you think the invoice is wrong)

Information supplied by—

• Your name

Your Email address

Telephone number (including STD, please leave out brackets)

Data protection Act 1998—relevant information given in this form may be disclosed to the Council's Benefits Service or to other council departments.