STANDARD FORM FOR PRESENTATION OF OVERCHARGE CLAIMS
Send to: UPS Freight
Phone Number
Overcharge Claims Department
804-231-8687
P.O. Box 1216
FAX (804) 232-6645
Richmond, VA 23209
ATTN. OVERCHARGE CLAIMS
CLAIMANT/PARTY to be refunded**: _________________________________
C/O ____________________________________________________
Address 1: ____________________________________________________
Address 2: _____________________________________________________
City: _____________________________________________
State: ________________ Zip-Code: __________________
** Only the party that made payment on original freight bill is eligible to receive
refund, unless paying party authorizes with assignment of interest.
THIS CLAIM IS FOR: $ _________________
Pro(s) ______________________ ______________________ ______________________
______________________ ______________________ ______________________
Note: If claim covers more than one item taking different rates and classifications, attach
separate statement showing how overcharge is determined. Please provide other
information that would help the processing of your claim i.e. check number(s) on each
pro/freight bill. Be specific as possible with your reason/tariff authority to avoid delay in
processing your claim.
REASON/TARIFF AUTHORITY FOR OVERCHARGE:
Note: When impossible for the claimant to produce original bill of lading or paid freight
bill, the bond of indemnity must be signed below to protect carrier against duplicate claim
filed by other parties who can produce original documents.
Bond of Indemnity
The undersigned guarantees to protect any carrier having an interest against any an all
loss, cost, and expenses including attorney fees, which may result to carrier from payment
of this claim by reason of our failure to support same with original paid freight bill.
Signature: ________________________________
Company: ________________________________
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