Pay Dispute Form
1) The Pay Dispute Form must be completed as follows a. Fill out one form for each dispute b. The dispute is for you NOT your partner c. Disputes should be filed between 25 and 30 days after game date d. Disputes filed between 31 and 45 days after game date will not receive priority e. Disputes filed 45 days after game date will not be accepted f. Disputes filed without an invoice and W9 will not be accepted. g. Contact the liaison(s) if you have problems filling out this form, or attaching the invoice and W9 2. Liaison will investigate the dispute, communicate updates as available until a resolution is achieved a. Additional information or follow up from the member may be needed during the investigation 1) Liaison will provide a time frame for the member to provide what is needed 2) The dispute will be dropped as unresolved if: a) the member does meet the time frame b) the member becomes uncooperative with the liaison
Last Name
First Name
Email
Phone Number
Game Date
Level of Game
Select an option
Varsity
Sub Varsity
Middle School
Charter School
Type of Game
Select an option
Regular
Tournament
Playoffs
Game 1 Home Team
60
Game 1 Visiting team
60
For each additional game provide home and visiting teams (ie. Game#-"Home team name" vs. "Visiting team name"
Dispute Type
Select an option
Non Payment
Incorrect Payment
Brief Discription:
Upload Invoice
Select a File
Document
Upload W-9
Select a File
Document
Upload Invoice
Select a File
Photo only
Upload W-9
Select a File
Photo only
I agree that I have read the pay dispute procedures and I have provided the proper documentation. I also agree to give the liaison full authority to investigate and perform needed actions to seek a resolution to my pay dispute as he deems necessary.
Submit
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