Billing Inquiry Form
Sales Form
Note:
*
indicates required field
Name:
*
Email:
*
Address:
*
City:
*
State/Province:
*
Country:
*
Zip/Postal Code:
*
Business Telephone:
*
(
)
Residence Telephone:
(
)
The complete billing name for this telephone account:
*
The complete billing address for this telephone account:
*
same as above
Area code and phone number that Integretel has billed:
*
(
)
The bill date of the local telephone company bill in question:
*
(This is usually located at the top of your summary page)
–
–
N/A
(MM–DD–YYYY)
What are the pre-tax dollar amounts of the Integretel charges on your local phone bill?
N/A
Please state your detailed inquiry regarding these charges:
*
Preferred contact method:
Telephone
Email
Postal Mail
If you prefer to be contacted by phone, please provide the best times we may contact you:
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