Billing Dispute Credit Request

Requester Full Name(Required)

Today's Date

FBL Customer Company Name(Required)

Enter the Fiberlight Contractual Customer Company Name. Please do not enter the FBL Customer’s end user name.

Customer Phone(Required)

Enter a phone number where you want to be contacted

FBL Customer POC(Required)

Enter the names of any additional points of contact Fiberlight should include in return communications. Please do not include your end user point of contact.

Customer Email(Required)

The email entered here will receive a confirmation email back with the ticket number for tracking and details of this Web Form Submission, so be sure you are entering that correct email to receive confirmation of this request.

Type of Request(Required)

Circuit Type(Required)

Enter the Type of Circuit you are referencing. Each separate Circuit will require it’s own Form submission.

Circuit ID(Required)

Enter known Lit or Dark Circuit ID Info as provided on your delivery notice. If not known, enter Unknown

OPP or Order Number(Required)

Enter the Order Number Info as provided on your contract. If not known, enter Unknown

Contract Number(Required)

Enter the Contract number Info as provided on your contract. If not known, enter Unknown

BAN (Billing Account Number)(Required)

Enter the billing account number as provided on your invoices

Monthly Service Charge(Required)

Is this request related to an outage?(Required)

Yes

What is the Ticket Number provided for the outage?(Required)

How long did you experience trouble?(Required)

Promotional ID

Additional Comments, Instructions or Contact Information(Required)

Include any Location information relevant to this request along with any other additional information, instructions or contact information. (Limited to 350 characters)

Upload Your KMZ File (ZIP required)

Accepted file types: zip, Max. file size: 10 MB.

.ZIP REQUIRED (please compress KMZ file in .ZIP format before uploading)

Upload Additional Documents

Accepted file types: jpg, gif, png, pdf, doc, docx, xls, xlsx, Max. file size: 10 MB.

Billing Dispute Credit Request

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