First Responder Toll Dispute

In accordance with state law and NC Quick Pass business policies, the North Carolina Turnpike Authority (AUTHORITY) allows the exemption of tolls for law enforcement, fire, rescue and emergency medical services vehicles (first responder vehicles) responding to emergency situations on all NC toll facilities. (See N.C.G.S. § 136-89.211(2)). A patron of any North Carolina toll facility is entitled to dispute any toll transaction(s) incurred in North Carolina through the completion and submittal of this form to NC Quick Pass.

To avoid liability, additional fees and penalties, disputes must be submitted within 30 days of the date on the NC Quick Pass statement (STATEMENT) or toll invoice (INVOICE). After 30 days the customer waives their right to dispute any and all tolls listed on the STATEMENT or INVOICE. Tolls will be imposed where the registered owner fails to provide accurate and complete information.

First Responder Toll Dispute Form

Agency Information

Agency Name(Required)

Contact Information

First Name(Required)

Last Name(Required)

Phone Number(Required)

Email Address(Required)

Confirm Email Address(Required)

Account Information

Invoice/Account Number(Required)

Date of Statement/Invoice(Required)

Disputed Toll Transactions

List the license plate/transponder, transaction date and time, toll zone, reason for dispute and amount for each dispute.

List the license plate/transponder, transaction date and time, toll zone, reason for dispute and amount for each dispute.(Required)

License Plate/Transponder

Transaction Date/Time

Toll Zone

Reason for Dispute

Amount

Printed Name of Customer to Sign(Required)

Total Amount(Required)

Customer Signature(Required)

Date(Required)

Comments

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