Claim Form

Date items were delivered*

Is this bill paid in full?*

Were the items stored in a warehouse?*

If "YES" then where?

I understand that I cannot repair or dispose of any item prior to carrier authorization and/or inspection. Any item which is repaired or disposed will void damage claim for that item. Also, I will not move an item prior to carrier authorization and or inspection or this will void any claim for the item(s) moved.

NOTE: If the item is repairable but you will accept a nominal cash allowance instead of repairs, enter the amount you are requesting. If repairs are preferred, click the "repair" box. Arrangements may be made to inspect the claimed item. However, please enter a dollar amount claimed and/or click the repair box for every item claimed.

Date Purchased

Indicate

Would you like to add another claim?