Inquiry form for all calls billed by Securus Correctional Billing Services (SCBS) I am the customer of record and party responsible for telephone service located at Email Address I hereby affirm that I did not accept charges and no other person having access to my telephone account accepted charges for, the following calls billed to my above referenced telephone account: Date Time From * * * Fields marked with an * are required. - Please use this pattern for time fields: 00:00 Phone fields must include only numbers and at least only 10 number digits for nationwide numbers and 15 digits for internationals as required. This document authorizes SCBS to conduct a complete investigation to determine why these calls were billed to my account. I understand that in order to fully investigate this matter, SCBS may access call recordings or other records pertaining to my telephone account and I authorize SCBS this access. For security purposes, and to ensure additional calls are not placed against my account, SCBS has proposed to block all future calls to my telephone account from correctional institutions served by SCBS. I authorize SCBS to take the following action: Yes, block my phone line from further incarcerated individual calls.No, do not block my phone line from further incarcerated individual calls, I understand I will be responsible for the changes associated with all accepted calls. I also understand that collection action may be taken for the charges associated with the SCBS calls appearing on my bill pending the outcome of the investigation. However, payment for all other charges is due by the date listed on my telephone bill. When SCBS has completed their investigation my account will be updated with actions taken to address these disputes. The investigation could take up to 5 days to complete upon receipt of form. I understand and agree that completing this form does not absolve me from financial responsibility for the calls being investigated. This form provides the authorization for SCBS to research and investigate the calls appearing on the above referenced telephone account. If SCBS determines that the calls under investigation were accepted, I understand I will be responsible for the call charges. If SCBS determines the calls were not legitimate, proper adjustments will be made to my telephone account to remove the charges. Date:
