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Get Freight Claim Form 2015-2024

PRO # & p/u date (If unknown, attach a copy of the Bill of Lading) PRO No. Shortage Your reference # (optional): Preparer’s Name: P/U date Damage Other (specify) Claimant’s CORRESPONDENCE (MAILING) address: Complete ONLY if different Make Check Payable (REMIT TO) Firm name (please print) Firm name (please print) Address Address City State Phone # Fax # Zip City State Phone # Fax # Zip Claimant’s Email address : Shipper Consignee Shipper City/State/Zip Consignee C.

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