Package Information
Package Information
Shipper 55Y1Y6
Page 1 of 3
Dear Customer:
We regret that your shipment with UPS was lost or damaged. In order to expedite the processing of a
claim, please promptly submit the required information listed below.
Please note that if you have already provided the documents required to process your claim, you may
disregard this notice. If necessary, UPS will contact you for any additional information.
1. Request for Claim Payment Form: Enter the lesser of the actual cost, replacement cost if the
merchandise can be replaced or or repair cost if the merchandise can be repaired, and transportation
charges.
2. Merchandise Value: A copy of the original invoice or other proof certified in writing sufficient
to identify the package contents and substantiate the lesser of the actual cost, replacement
cost or repair cost of the merchandise.
3. Shipping Record: A copy of the shipping record for the above package.
To file a claim by fax or mail see the enclosed Request for Claim Payment Form.
We apologize for any inconvenience this may have caused. We strive to provide quality service and
look forward to serving you in the future. If you have any questions or need further assistance, please
call 1-800-PICK-UPS . Please refer to your shipper number and claim number.
DAMAGE/LOSS NOTIFICATION
INQUIRY FROM: JAMES TERWILLIGER
SOURCED MATERIALS
6314 SPRINGVILLE HWY
ONSTED MI 49265
WE HAVE BEEN UNABLE TO PROVIDE SATISFACTORY PROOF OF DELIVERY FOR THE ABOVE
SHIPMENT. WE APOLOGIZE FOR THE INCONVENIENCE THIS CAUSES.
T890NTFM:000A0000 LDI 27
May 20, 2010
Shipper 55Y1Y6
Page 3 of 3
Transportation Charges:
Total Amount Requested:
Please provide a contact name and telephone number in the event further communication is necessary.
CONTACT NAME: PHONE:
Please provide any additional Tracking Number(s) for the above shipment:
Tracking
Number(s):
To File a claim by Fax:
Fax this completed Request for Claim Payment form and your other documents to: 1-888-458-7703
To File a claim by Mail:
Mail this completed Request for Claim Payment form and your other documents to:
T890NTFM:000A0000 LDI 27
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