DOJ-OGR-00015444.jpg
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Document Information
Type:
Business form
File Size:
490 KB
Summary
This document is a blank FedEx Adjustment Request form associated with invoice number 4-495-45970, dated December 16, 2002, for account number 1144-2081-6. The form provides instructions and reason codes for a customer to dispute charges by faxing the completed form to FedEx. It also includes a section for updating the account's address information.
Organizations (2)
| Name | Type | Context |
|---|---|---|
| FedEx | company |
The document is a FedEx Adjustment Request form.
|
| Federal Express | company |
Mentioned below the FedEx logo in the address change section.
|
Full Extracted Text
Complete text extracted from the document (1,302 characters)
FedEx.
Invoice Number: 4-495-45970
Invoice Date: Dec 16, 2002
Account Number: 1144-2081-6
Page: 2 of 9
Invoice Date: Dec 16, 2002
Account Number: 1144-2081-6
Page: 2 of 9
Adjustment Request
FAX TO (800) 548-3020
FAX TO (800) 548-3020
Tracking No./Airbill No.
Reason Code
Explanation
Reason Code
Explanation
BEFORE YOU FAX
Please include detailed explanation for each adjustment request.
Remember to include recipient's account number or third party's account number if applicable.
Please include detailed explanation for each adjustment request.
Remember to include recipient's account number or third party's account number if applicable.
From:
Name
Date
( ) Business Phone
( ) Business Fax
Name
Date
( ) Business Phone
( ) Business Fax
REASON CODE KEY
Reason Code Description
DUP Duplicate Billing
PND Shipment Never Sent
RATE Incorrect Rates or Pieces
RRA Rebill Recipient - Include Recipient's Account No.
RSA Rebill Sender
RTA Rebill Third Party - Include Third Party's Account No.
SUR Incorrect Surcharge - Please Explain
OTHR Other - Please Explain
Reason Code Description
DUP Duplicate Billing
PND Shipment Never Sent
RATE Incorrect Rates or Pieces
RRA Rebill Recipient - Include Recipient's Account No.
RSA Rebill Sender
RTA Rebill Third Party - Include Third Party's Account No.
SUR Incorrect Surcharge - Please Explain
OTHR Other - Please Explain
This form cannot be used to request Invoice Adjustments due to Service Failures or lack of a POD.
To request adjustments for Service Failures or lack of a POD, please call 1-800-622-1147,
visit our internet site at www.fedex.com or register for FIO.
To request adjustments for Service Failures or lack of a POD, please call 1-800-622-1147,
visit our internet site at www.fedex.com or register for FIO.
FedEx
Federal Express
Please indicate change in address for the account # listed below
Account Number 1144-2081-6
Federal Express
Please indicate change in address for the account # listed below
Account Number 1144-2081-6
Physical Address
Billing Address
Mailing Address
Billing Address
Mailing Address
Name:
Address:
Apt. / Suite:
City:
State:
Zip:
Phone: ( )
Fax: ( )
Authorizing Signature:
Address:
Apt. / Suite:
City:
State:
Zip:
Phone: ( )
Fax: ( )
Authorizing Signature:
CONFIDENTIAL
SDNY_GM_00340796 135
DOJ-OGR-00015444
DOJ-OGR-00015444
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