Printable Business Form Templates
Damage Claim Business Form Template

Loss and Damage Claim

Form fields: send or fax claim to, make check payable to, claimant, address, city, state, zip, reference or claim #, claim amount, claim for, shortage, damage, other, shipper, origin, consignee, destination, carrier pro #, pickup date

Briefly describe the claim and how the amount was calculated:

If the claim involve damaged goods, please check one:

__damaged goods can be replaced for approximately $_________

__damaged goods can be repaired for approximately $_________

__damaged goods are available for carrier pickup.

__damaged goods are unavailable (please explain)

Please attach the appropriate documentation:

__vendor's invoice showing price of lost or damaged goods, including final page.

__consignee's copy of the freight bill bearing loss or damage notations.

__itemized repair bill, if applicable.

__inspection report, if available

Claimant's Signature & Date:

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