*Customer Name:
(As it appears on the statement) |
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*Account Number:
(As it appears on the statement) |
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| *Contact's Name: |
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| *E-Mail Address |
disclaimer
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| *Repeat E-Mail Address: |
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| *Phone Number: |
Extension (Optional)
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| *Fax Number: |
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| Type of Query
Whats This?
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| *AP Contact: |
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| *Address: |
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| Attach letterhead: |
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| OR |
| fax to (734) 477 1278 for Borders |
| fax to (734) 477 4760 for Waldenbooks |
| *Check Number: |
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| *Check Date: |
mm/dd/yyyy
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| *Check Amount: |
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| *Address Check Mailed To: |
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| *Date Check Mailed: |
mm/dd/yyyy
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| *Invoice Number: |
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| *Invoice Date: |
mm/dd/yyyy
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| *Invoice Amount: |
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| *Check Number: |
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| *Check Date: |
mm/dd/yyyy
|
| *Check Amount: |
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| *Address Check Was Mailed To: |
|
| *Date Check Mailed: |
mm/dd/yyyy
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| *Invoice Number: |
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| *Invoice Date: |
mm/dd/yyyy
|
| *Invoice Amount: |
|
| *Invoice Number: |
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| *Invoice Amount: |
|
| *Invoice Date: |
mm/dd/yyyy
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| *Reason For Error: |
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| *Refund Amount: |
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| *Refund Reason: |
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| *Mailing Address: |
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| *Request Check Copies: |
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| *Name of Company: |
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| *Inquiry Details: |
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| Additional Comments |
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