Toll Payment Duplicate Charge Dispute Form
Use this form to report and dispute duplicate toll payment charges. Please provide accurate trip and charge details for prompt review.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Vehicle License Plate Number
*
Toll Trip Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Toll Trip Location (Toll Road/Plaza Name)
*
Duplicate Charge Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Duplicate Charge Amount
*
Duplicate Charge Reference or Transaction ID
Upload Supporting Evidence (e.g., receipts, statements)
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