U-PIC Insurance Services Affidavit

Click Here to Check Out Our Daily Deals. Login | Help | Wish List | Contact Us

0 items

U-PIC Insurance Services Affidavit
For Lost or Damaged Parcels

CLAIM INFORMATION SHEET

Order Number: *

Name: *

Shipping Address: *

City: *

State / Province: *

Zip Code *

Phone: *

Contact:

E-Mail *

CLAIM DETAIL

Lost Damage Incomplete:

Tracking numbers:	Claim ID: (For Internal Use)
1.	1.
2.	2.
3.	3.
4.	4.
5.	5.

If item is damaged, please describe and attach picture of damage:

Describe condition of package:

I hereby certify that all information on this form is accurate and truthful. The submission of a false, fictitious or fraudulent statement may result in imprisonment of up to 5 years and a fine of up to $10,000.00 (18 USC 1001). In addition, a civil penalty of up to $5,000.00, and an assessment of twice the amount falsely claimed may be imposed (31 USC 3802).

Signature: *

Date: *

Re-send or refund policy:
Please check either resend, refund, OR In-store Credit

1. Resend

Please notice for resend order over $200, signature is required.
All order under $10.00 will refund only.

2. Refund

3. In-store Credit

You may send this claim form by mail:

Meritline.com
18961 E. Arenth Ave. City of Industry, CA 91748
Email: order@meritline.com

Customer Service

Policies