FedEx.
Invoice Number: 4-487-30791
Invoice Date: Dec 13, 2002
Account Number: 2292-0750-4
Page: 2 of 4
Adjustment Request
FAX TO (800) 548-3020
Tracking No./Airbill No. Reason Code Explanation
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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.
From:
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
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.
FedEx
Federal Express
Please indicate change in address for the account # listed below
[ ] Physical Address [ ] Billing Address [ ] Mailing Address
Account Number 2292-0750-4
Name:
Address:
Apt. / Suite:
City:
State:
Zip:
Phone: ( ) Fax: ( )
Authorizing Signature:
CONFIDENTIAL
SDNY_GM_00340730 111
DOJ-OGR-00015420
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