Damaged Shipment Claims Form

Claimant:

Company Name:

Address:

City/State/Zip:

Phone Number:

Email:

Shipper:

Address:

City/State/Zip:

Consignee:

Address:

City/State/Zip:

Claimant's Reference Number(s):

Claim Information:

Noted Damage

Concealed Damage

Shortage

Other (explain)

Damaged goods can be used for an allowance of $

Damaged goods can be repaired for $

Damaged goods are located at

Damaged goods are not available (explain)

Pieces:

Weight:

Used:

Description:

Amount Claimed:

Total: $0.00

CLAIMS