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He options above that I am not responsible for the toll transaction(s) documented. I understand that if the required documentation is not submitted, my request will not be processed and additional information may be required to continue with my dispute. Name (Type or Print Legibly): Si gnature: Dat e: www.RiverLink.com / 1-855-RIV-LINK (1-855-748-5465) / customerservice@riverlink.com P.O Box 16799 Austin, TX 78761 .

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