May 20, 2010
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.
Documents needed to file a claim:
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 electronically:
- For customers with access to Claims on ups.com:
https://wwwapps.ups.com/webClaims/create?loc=en_US
- For other claims:
https://wwwapps.ups.com/dua/upload?loc=en_US
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.
UPS Customer Service
May 20, 2010
Shipper 55Y1Y6
Page 2 of 3
ATTN : JAMES TERWILLIGER
PHONE : (517)467-3010
DAMAGE/LOSS NOTIFICATION
INQUIRY FROM: JAMES TERWILLIGER
SOURCED MATERIALS
6314 SPRINGVILLE HWY
ONSTED MI 49265
SHIPMENT TO: RICARDO PENA/ ORDER ID#67180
EAGLE TECHNOLOGIES SUPPLY IN
13713 N UNITEC DR
LAREDO TX 78045
Shipper Number............................ 55Y1Y6 Pickup Date....................................05/04/10
Number of Parcels........................ 3 Weight.............................................16
Tracking Identification Number... 1Z55Y1Y60359867692 Consignee P.O. Number............... 67180895
Merchandise.................................. cleaner
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
REQUEST FOR CLAIM PAYMENT
If you are filing your claim electronically, please complete this form online. To fax or mail your claim,
please complete this form, using black ink only. Include the lesser of your actual cost of the
merchandise, replacement cost or repair cost if repairable. Specify which cost you are including.
Include your transportation charges. The preceding letter includes instructions on filing a claim and a
toll free fax number for your convenience 24 hours a day. For future reference, this claim is identified
by Shipper Number 55Y1Y6 , and Claim Number 9732393701A.
SHIPMENT TO: RICARDO PENA/ ORDER ID#67180
EAGLE TECHNOLOGIES SUPPLY IN
13713 N UNITEC DR
LAREDO TX 78045
Shipper Number............................ 55Y1Y6 Pickup Date....................................05/04/10
Number of Parcels........................ 3 Weight.............................................16
Tracking Identification Number... 1Z55Y1Y60359867692 Consignee P.O. Number............... 67180895
Merchandise.................................. cleaner
Could this merchandise be replaced for your customer? Yes No
If damaged, is the merchandise repairable? Yes No
If damaged, UPS may issue a Recovery Call Tag to take possession of the merchandise.
Quantity Merchandise Description Specify Dollar Amount and Indicate Whether
Actual, Replacement or Repair Cost
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:
Claims Processing Center
P.O. BOX 1265
Newport News VA 23601-1265
T890NTFM:000A0000 LDI 27
**AARGGLQ403**
