National Claims Service LLC
Continuation form
*Indicates Response Required
Property Owner's Name
*
First Name
Mid Init.
*
Last Name
Point of Contact Name
Contact First
Contact Last
*
Street Address
Address Line 2
*
City
STATE
*
Zip/Cntry Code
*
Country
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Phone Number
Alt. Phone Number
*
Email Address
*
GBL Prefix
*
GBL #
*
Pick Up Date
*
Delivery Date
*
Origin of Shipment
*
Destination of Shipment
Rank
*
SCAC
Service Code
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Enter Items below:
INV#
Item Desc.
Damage Desc.
QTY
Value $
Repair $
*
Indicates Response Required