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Fillable Printable Notice Of Overcharge

Fillable Printable Notice Of Overcharge

Notice Of Overcharge

Notice Of Overcharge

GENERAL SERVICES ADMINISTRATION
GSA 7925 (REV. 10/1989)
NOTICE OF OVERCHARGE
RUN DATE CARRIER
SCAC
AGENCY CODE
REVIEWER NUMBER
DATE BILL PAID
CONTRACTOR
TELEPHONE NUMBER
MODE FOREIGN CURRENCY
SHIPPING DATE
PLEASE FURNISH A COPY OF THIS FORM WITH ALL CORRESPONDENCE,
MAKE CHECK PAYABLE TO "GENERAL SERVICES ADMINISTRATION."
SHIP SPECIFIC NUMBER CARRIER BILL NUMBER
DRN
AUDITOR NUMBER
MAIL
TO
GENERAL SERVICES ADMINISTRATION
P.O. BOX 93746
CHICAGO, IL 60673
THIS OVERCHARGE AMOUNT SHOULD BE PROMPTLY REFUNDED OR EVIDENCE FURNISHED TO SUPPORT CHARGES ORIGINALLY PAID;
OTHERWISE, COLLECTION ACTION MUST BE INITIATED PURSUANT TO 31 U.S.C. 3726.
AMOUNT
PAID
SHOULD BE
AMOUNT
AMOUNT OF
OVERCHARGE
INTEREST
TOTAL AMOUNT
OF OVERCHARGE
BASIS OF OVERCHARGE
DIRECTOR, TRANSPORTATION AUDIT DIVISION
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