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Damage & Return Claim Form REVISED[1]

Con dential Page 1 revised 7/07/2014 Claims Department Damage & Return Claim FORM2100 E Grand Ave., Suite 600 El Segundo, CA 90245 | Fax Claim Number: C -SECTION I. GENERAL INFORMATION (Customer must ll out Section I and Section II) Today s Date: Customer Name: Account Number: Purchase Order Number: Contact Name: Phone Number/Extension: SECTION II. Claims must be filed within 15 days calendar from date of delivery. Pictures of damaged goods and the original cartons are required and must accompany your Claim . Failure to include these documents will delay or deny processing of your Claim .

Title: Microsoft Word - Damage & Return Claim Form_REVISED[1].doc Author: Teresa May Created Date: 11/12/2012 3:29:53 PM

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