Preliminary Notification Form of Shipment Loss or Damage

NOTE: COMPLETION OF THIS FORM DOES NOT CONSTITUTE A FORMAL CLAIM

Please fill out the information below as completely as possible then click “Submit” to begin the shipment damage or loss claims process.

By filling out this information inaccurately, your claim may be denied.

Upon submission, a formal claim will be sent to the billable party within five business days via the contact method selected below.

Fields marked in bold are required

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Customer Information
First Name:
*required
Last Name:
*required
Company:
*required
Country:
v
*required
Address 1:
*required
Address 2:
City:
*required
State:
v
*required
ZIP/Postal Code:
*required
*invalid
Phone:
*required
*invalid
Fax:
*invalid
E-Mail:
*required
*invalid
Contact Via:
v
*required
Shipment Details
Shipment Number:
*required
*invalid
Claimant Reference Number:
Pickup Date:
v
Delivery Date:
v
*required
Claimant Role:
v
*required
Type Of Claim:
v
*required
Total Pcs Shipped:
*required
*invalid
# of Pcs Lost/Damaged:
*required
*invalid
Commodity/Desc. of Goods (75 characters available):
*required
Extent of Damage (50 characters available):
*required
Comments/Additional Information:
*something is wrong or missing in one or more of the fields