Ride Reservation Cancellation Fee Dispute Form
Use this form to submit a dispute for a cancellation fee related to a ride reservation and provide the details and evidence needed for review.
Rider Information
Rider full name
*
First Name
Last Name
Email address
*
example@example.com
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred contact method
*
Email
Phone
Text message
Ride Reservation Details
Reservation / Booking ID
*
Ride Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Ride Time
*
Hour Minutes
AM
PM
AM/PM Option
Pickup Location
*
Drop-off Location
*
Ride Provider / Driver Name
Cancellation Details
Cancellation date and time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Who cancelled the reservation?
*
Rider
Driver
Support
Other
Date cancellation fee was charged or appeared
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Stated cancellation fee amount (USD)
*
Dispute Information
Reason for Dispute
*
Cancelled within allowed time
Driver did not arrive
App/system error
Ride provider changed pickup time
Duplicate fee
Other
Detailed Explanation of the Dispute
*
Supporting Evidence
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Requested Resolution and Acknowledgment
Requested Resolution
*
Refund full fee
Refund partial fee
Review and explain charge
Other
Additional Comments
Acknowledgment
*
I confirm the information submitted is accurate and I request review of this cancellation fee dispute.
Submit Dispute
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