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CLAIMS FORM

Please fill out the form with all the required fields to submit a claim on your shipment.

1Claimant Information

2Claim Information

3Required Documents

4Summary

5Submit Claim

CLAIMANT INFORMATION

Company: *

Company Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Phone: *

Fax:

Email: *

CLAIM INFORMATION

Lighthouse Shipment Number: *

Carrier PRO Number: *

Item 3: Copy

Claim is filed for: *

(Number and description of articles, nature and extent of loss or damage, invoice price of articles, amount of claim, etc.)

Item 1: *

Item 1 Total: *

Item 2:

Item 2 Total:

Item 3:

Item 3 Total:

Item 4:

Item 4 Total:

Item 5:

Item 5 Total:

Total Amount of Claim:

Your total is automatically added together.

REQUIRED DOCUMENTS

Claim cannot be processed without invoice.

Original Commercial Invoice: *

Click or drag a file to this area to upload.

(Certified copy acceptable). A commercial invoice is the actual invoice indicating the cost of all the items contained in this shipment.

Copy of the Delivery Receipt: *

Click or drag a file to this area to upload.

With exception notation.

Copy of the Bill of Lading: *

Click or drag a file to this area to upload.

Detailed Repair Invoice:

Click or drag a file to this area to upload.

Only send if claim is for repair of damage. Invoice must show cost of material, labor, etc.

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SUBMIT CLAIM

To complete your claim, please provide your signature below.

SALVAGE RETENTION

Any and all merchandise, to and including damaged parts, must be held for carrier disposition. Failure to do so could result in declination of your claim.

Signature: *

Clear Signature