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Fed >< Invoice Number: 4-397-85573 e Invoice Date: Oct 14, 2002 Account Number: 1144 2081 6 Page: 2of9 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 Recipient's Account No. Remember to include recipient's account number or third party's account number if applicable. From: Rebill Sender Rebill Third Party Include ell Third Party's Account No. Name Date Incorrect Surcharge Please Explain ( ) ( ) Other Please Explain Business Phone Business Fax 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, Fedex< Federal Express visit our internet site at www.fedex.com or register for FIO. Please indicate change in address for the account # listed below: im Physical Address LC] Billing Address LO Mailing Address Account Number: 1144-2081-6 Name: Address: Apt. / Suite: City: State: Zip: Phone: ( ) Fax: ( ) Authorizing Signature: DOJ-OGR-00016086