Claim Form

All red fields are required.
(Highlighted fields may not represent required fields.)

Claimant
Address
City
State Zip 
Phone

Name of Shipper
Origin
PRO#
Dollar 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 pick-up.
     Damaged goods are unavailable for carier pick-up.
To avoid delay in processiog your claim, please FAX appropriate documents to 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 Phone
E-mail
Your Fax

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



Created by Oak Hill Internet Design © 2005-2007.