Damaged Shipment Request DAMAGED SHIPMENT REQUEST FORM Customer Name*Requested By*Delivery Date* MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*PO Number*Order/Invoice NumberItem Number*Quantity*Serial NumberCheck All That Apply* Seal Broken Open Box Apparent Damage Concealed Damage Refused Shipment Details* Signed for Free and Clear Partial Shipment Refused Entire Shipment Refused Exception Number from DriverCommentsPhoto Details Required Must include photos with details of packaging to include broken seals and/or open boxes. Must include photos from all sides of box and item enclosed.Files Drop files here or Select files Accepted file types: jpg, png, pdf, jpeg, Max. file size: 5 MB.
