Full Name:

[Your Name]

Account Number:

Contact Email:

Contact Number:

Address:

Have you received the final invoice?

• Yes

• No

Invoice Number:

[Invoice Number]

Are there any discrepancies in the invoice?

• Yes

• No

If yes, please specify:

[Specify Discrepancies]

Is the listed contact information correct on the invoice?

• Yes

• No

• Needs Correction

Preferred payment method:

• Bank Transfer

• Credit Card

• Cheque

• Online Payment

If Bank Transfer, is your bank account information up-to-date?

• Yes

• No

• Update Required

If Credit Card, are you authorizing automatic payments?

• Yes

• No

If Cheque, do you require a mailing address?

• Yes

• No

For Online Payment, which platform do you prefer?

• PayPal

• Stripe

• Other (Please specify)

Do you agree to the total amount due as stated on the invoice?

• Yes

• No

• Dispute

If disputing, specify the amount you believe to be correct:

$ [Amount]

Do you require a payment plan?

• Yes

• No

If yes, what payment interval is preferred? (Monthly, Quarterly)

Date by which you can make the first payment:

Overall, how satisfied are you with the services provided?

• Very Satisfied

• Satisfied

• Neutral

• Unsatisfied

• Very Unsatisfied

Were there any issues with the service delivery?

• Yes

• No

If yes, please describe:

How likely are you to use our services again?

• Very Likely

• Likely

• Unsure

• Unlikely

• Very Unlikely

Any suggestions for improving our service or settlement process?