E Incorrect Rates or Pieces RRA Rebill Recipient Include Recexenrs Account No. RSA Rebill Sender RTA Rebel Third Party Include Third Party's Accotni No. SUR Incorrect Surcharge - Please Explain OTHR Other - Please Explain This form cannot be used to request Invoice Adjustments due to Service Fai

Inccerect Rates or Pieces RRA Rebill Recipient Include Recipenrs Account No. RSA Rebill Sender RTA Rebill Third Party Include Third Party's Accotni No. SUR Incorrect Surcharge - Please Explain OTHR Other - Please Explain This form cannot be used to request Invoice Adjustments due to Service Fai

Incorrect Rates or Pieces RRA Rebill Recipient Include Recipenrs Account No. RSA Rebill Sender RTA Rebill Third Party Include Third Party's Accotni No. SUR Incorrect Surcharge - Please Explain OTHR Other - Please Explain This form cannot be used to request Invoice Adjustments due to Service Fai

Incorrect Rates or Pieces RRA Rebill Recipient Include Reg:cents Account No. RSA Rebill Sender RTA Rebill Third Party Include Third Party's Accotni No. SUR Incorrect Surcharge - Please Explain OTHR Other - Please Explain This form cannot be used to request Invoice Adjustments due to Service Fai

E Incorrect Rates or Pieces RRA Rebill Recipient Include Recipenrs Account No. RSA Rebill Sender RTA Rebid Third Party Include Third Party's Accotni No. SUR Incorrect Surcharge - Please Explain OTHR Other - Please Explain This form cannot be used to request Invoice Adjustments due to Service Fai

Incorrect Rates or Pieces RRA Rebill Recipient Include Recipenrs Account No. RSA Rebill Sender RTA Rebill Third Party Include Third Party's Accotni No. SUR Incorrect Surcharge - Please Explain OTHR Other - Please Explain This form cannot be used to request Invoice Adjustments due to Service Fa