Warehouse Business Office

SIMPLIFIED CARGO LOSS OR DAMAGE CLAIM FORM
Please fill-in the form below. Asterisk(*) in RED are required.

Today's Date: *
Customer PO #: *
 
CLAIMANT INFORMATION:
Company Name *
Address
City
State/Zip
Phone * ( ) -
Email *
Confirm Email *
Fax
Completed by *
   
 
All Correspondence and Documents should be forwarded to :
Fournier Trucking
P.O. Box 39
Clearwater, MN 55320
[email protected]
Fax: 320-558-4698
 
Total Claim Amount (USD) $: is made against Fournier Trucking, Inc.
Check one: damage shortage other
 
If different than Claimant:
Shipper  
Name
City
State/Zip
Pick-up Date
Shipper Rel #
 
If different than Claimant:
Consignee  
Name
City
State/Zip
Delivery Date
PO # / Pro #
ADDITIONAL INFORMATION HERE:
Include Copies of:
1. Original Invoice (showing cost of item claimed, NOT retail price)
2. Bill of Lading
3. Paid Freight Bill
Number of additional sheets attached: *

Questions? Call 1-877-743-2258

 
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