Fillable Notice of Dispute Instructions Please use this form

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Notice of Dispute Instructions Please use this form

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Notice of Dispute
Account Holder’s Information
For privacy reasons, the AT&T Legal Department is only able to communicate with the account
holder or a legal representative. Please have the account holder submit this Notice of Dispute to begin the
60-day resolution process.
Page 1 of 5
Account Holder’s Billing Address (*Required field)
*Street
*City *State
*Zip/Postal Code *Country
*Account Holder’s Billing Phone
*Are you the account holder?
Account Holder’s Billing Email
Yes No
Instructions
Please use this form to notify AT&T’s Legal Department of your dispute. Include any supporting
documents. You may want to include bills, notes, chat transcripts, communications with AT&T, and/or
advertisements.
Mail this completed form and supporting documents to:
AT&T Office for Dispute Resolution
1025 Lenox Park Blvd.
Atlanta, GA 30319
If the Legal Department has not resolved your dispute within 60 days of receiving your completed form,
you may bring a small claims lawsuit or file an arbitration demand with the American Arbitration
Association. For more information, please visit att.com/support/article/wireless/KM1045585/.
Account Holder’s Name (*Required field)
*First Name
Jr./Sr.
M.I. *Last Name
For security purposes, the AT&T Legal Department may only contact the customer at a phone number or
email on file with the account.
Notice of Dispute
Page 2 of 5
Legal Representative’s Information (*Required field)
If you are the account holder, you may proceed to the next page. Only complete this form if you are NOT
the account holder.
*What is the basis of your authority?
Attorney/Trustee/Other’s Name (*Required field)
Attorney/Trustee/Other’s Address (*Required field)
*Street
*City *State
*Zip/Postal Code *Country
*Attorney/Trustee/Other’s Phone *Attorney/Trustee/Other’s Email
*First Name Jr./Sr.M.I. *Last Name
*Are you a Legal Representative representing the customer?
Attorney
Trustee Other:
Law Firm [if applicable] License # [if applicable]
AT&T has permission to contact the account holder(s) to confirm they authorize AT&T to speak with
you about this Notice of Dispute.
Notice of Dispute
Account Information
Is this a business or residential account?
Business
Residential
Page 3 of 5
Which account is in dispute? Check all that apply and provide the account number for each.
At least one is required.
Phone Number:
AT&T Mobility (post-paid)
Phone Number:
AT&T PREPAID
Phone Number:
Landline
Account Number:
Internet (DSL, U-verse, dial-up, AT&T Internet)
Account Number:
Video (AT&T TV, U-verse, DIRECTV, AT&T Now)
Account Number:
Digital Life
Are you making a property damage claim?
Yes
No
Notice of Dispute
Page 4 of 5
Dispute Details (*Required field)
*What issue(s) does your dispute involve? (Please explain your dispute in detail.)
*Are you seeking monetary compensation? If so, please enter the total amount requested and explain
how you calculated the amount.
Date Range of issue(s)
*From
Month
Day Year Month Day Year
*To
$ .
Notice of Dispute
Page 5 of 5
Dispute Details (continued)
*Other than monetary compensation, is there any other relief requested? If so, please explain.
*Please list any previous efforts to resolve this dispute. With whom and when did you speak with
Customer Care? Do you have the call reference number?
Please include any supporting documents. You may want to include bills,
notes, chat transcripts, communications with AT&T, and/or advertisements.
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Notice of Dispute Instructions Please use this form

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Completed 12 March 2021

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