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Fed =< Invoice Number: 4-495-33932 e Invoice Date: Dec 16, 2002 Account Number: 1144 20816 Page: 20f 15 Adjustment Request FAX TO (800) 548-3020 Tracking No./Airbill No. Reason Code Explanation BEFORE YOU FAX REASON CODE KEY Please include detailed explanation for each adjustment request. Description Duplicate Billing Shipment Never Sent Incorrect Rates or Pieces Rebill Recipient Include Remember to include recipient's account number or third parly's account number if applicable. Recipient's Accaunt No. Rebill Sender Rebill ThirdParty Include Third Party's Account No. Incorrect Surcharge Please Explain ( ) ( ) Other Please Explain Business Phone Business Fax Name Date 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, visa our internet site at www.fedex.com or register for FIO. Federal Express Please indicate change in address for the account # listedbelow: _] Physical Address L] puting Address [_] sailing Address Account Number: 1144-2081-6 Name Address: Apt. / Suite: City: Slate: Zp: Phone: ( ) Fax: ( ) Authorizing Signature: DOJ-OGR-00016050