Overcharge Claims Form

* indicates required field

Date(MM/DD/YYYY):*
Claim #:*

Form for Presentation of:

Overcharge Claim
Duplicate Payment

Claim Amount:* $

Description of Shipments:

Name & Address of Consignor (Shipper):

Name & Address of Consignee (Receiver):

Detailed Statement of Claim

Freight Bill #*	Date (MM/DD/YYYY)*	Description	Weight	Rate	Freight Charges*
	Click Add Row for additional line. Freight Bill #, Date and Freight Charges are required on the first line.				Charges Are:

Charges Are Total:

Freight Bill #*	Date (MM/DD/YYYY)*	Description	Weight	Rate	Freight Charges*
	Click Add Row for additional line. Freight Bill #, Date and Freight Charges are required on the first line.				Charges Should Be:

Charges Should Be Total:

Amount of Overcharge:
Authority for Rate Classification Claimed:*

Additional Documents
Original Paid Freight Bill
Freight Bill Paid Information
Original Invoice or Certified Copy When Claim Is Based on Valuation or When the Shipment Has Been Improperly Described
Original Bill of Lading, When Shipment Was Prepaid, or When Claim Is Based on Valuation or Description
Weight Certificate

Name of Claimant:*

Email Address:*

Address of Claimant:

Form will be submitted via email to the Overcharge Claim Department
Every effort will be made to process your claim within 30 days of receipt