Claim Form
» denotes required form fields
» Claimant:
» Address:
» City: » State:
Zip: Country:
» Telephone: » Email:

» Shipper:
» Origin:
» PRO#:
» Amount: $
» Consignee:
» Destination:
» Delivery Date:

» Briefly describe what the claim represents and how the claim amount was calculated.

If the claim involves damaged goods, please check one or more of the following.
Damaged goods can be repaired for approximately: $
Damaged goods can be used 'as-is' for an allowance of: $
Damaged goods are available for carrier pickup.
Damaged goods are unavailable for carrier pickup.

To avoid delay in processiog your claim, please FAX appropriate documents to +1-715-749-9086.
Vendors invoice showing price of lost or damaged goods (including the final page).
Consignee's copy of the freight bill bearing loss or damage notations.
Itemized repair bill, if applicable.
Inspection report, if available.

» Your Name:
» Your Tel: » Your Fax:
» Your Email:

Please remember to fax in your supporting documents to +1-715-749-9086 or your Claim will not be processed.

Support contact:
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