File A Claim

Shipped Date
MM slash DD slash YYYY
NSD ORDER #*
CLAIMANT #
FREIGHT BILL / PRO #
ACCOUNT #
CLAIMANT*
Company Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
CONSIGNEE*
Company Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
CLAIM TYPE*
- Shortage / Lost
- Damage
PRODUCT COST*
FREIGHT COST
TOTAL CLAIM COST
DESCRIPTION OF HOW CLAIM WAS CALCULATED
Please list the damaged/lost articles below*
Item Description # of Pieces Product Cost
The following files are submitted in support of the Claim
- Vendor Invoice
- Copy of Bill of Lading
- Copy of Proof Delivery
- Other
Upload File(s)
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The foregoing statement of facts is hereby certified to as correct:
Claimant*
Company
Name
First Last
Email*
Enter Email Confirm Email

Item Description	# of Pieces	Product Cost

The foregoing statement of facts is hereby certified to as correct: