Zenith Freight Lines


	claim form OS&D policy routing instructions

Claim Form

All pieces should be inspected at time of delivery for damage. Concealed damage must be reported within 30 days of date of delivery.

Please submit separate report for each damaged piece


Carrier Name:	Manufacturer:


Carrier Pro Number#:


Date of Delivery: (ex: 00-00-00)	Consignee:


Date Mdse Unpacked:	Date Reported to Carrier:


Type of receiving facility:	Dock:	Street-level:	Other:

Describe handling procedures at receiving facility:


Describe condition of packaging:
Outer:		Inner:

In your opinion, what was the cause of the damage?

Present location of damaged item?


Was item moved from original delivery location?	*Yes	No	*If yes, specify date, distance, and responsible party:


#Pcs	Ack# or PO#	Item#


Description of damage or defect		Your Cost of Item


Specify your preference but be advised all claims are processed following the guidelines set by both carrier and manufacturer:
	Carrier to Pick-up for inspection.
	Parts needed to repair in house (no cost incurred for parts or labor)
	Customer to repair using outside service - Requires a written estimate be submitted for APPROVAL BEFORE any repair is made.
	Estimated repair cost: $
	Reimbursement Only - Store does not want replacement at this time. Requires damaged piece to be returned for inspection before any claim can be processed for payment.
	REPLACE - not repairable ( may require pictures )



Company:		Phone#

Address:		Fax#

Contact:

Signature:		Position

Date: