eBay Claim Form

  Instructions:
  1) Print form
  2) Fill-out
  3) For faster processing time, fax the Claim Form to 1-877-814-3953 (allow 21 days for a reply) Or Mail Claim Form to address below (allow 45 days for a reply)
  Claim Reason:   Misrepresentation Non-delivery
Buyer Name: ___________________________________________________________________
Email Address: ___________________________________________________________________
Street Address: ___________________________________________________________________
City/State/Zip: ___________________________________________________________________
Country: ___________________________________________________________________
Item #: _________________     Method of payment ______________________________

Winning Bid Amount: _________________    Currency Paid In:_____________________

Problem Description:________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Seller Email Address:__________________________
Address where payment was sent:
Name:_____________________________________
Street Address:______________________________
City/State/Zip:_______________________________
Country:___________________________________

***Below is the required information to file a claim***
 
  1. Signed Claim form (required)
  2. Proof of Payment (required) For credit card payments: proof of denial for reversal of charge (also referred to as charge-back) by card issuer is also required.
  3. *Appraisal or Proof of Authenticity based on an independent authenticator's physical inspection (*required for Misrepresentation claims-must include contact name and number for authenticator)
Please fax only the above documentation, if the claims adjuster needs additional information they will request it at a later time. Make sure the above information is complete. Claim processing may be denied or delayed without required information. All of the required documents must be received by the Claims Administrator within 90 days of the end of the listing in order for your claim to be processed. Claims received after 90 days of the end of the listing will be denied.

Any person who, knowingly and with intent to injure, defraud or deceive, files a statement of claim or an application containing false, incomplete, or misleading information may be guilty of a criminal offense and will be prosecuted to the fullest extent of the law. By filing this claim, you are confirming that you understand and agree to the terms of the eBay User Agreement and the conditions of the eBay Fraud Protection program.

I hereby attest that all of the information contained in this document is true and accurate.

___________________________________
Claimant Signature                           Date

Send or Fax Claim Form & Supporting Documentation to:
Fraud Protection Program
Attn: Claims Administration Dept.
P.O. Box 188
Draper, Utah 84020
Fax: 1-877-814-3953