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CLAIM REGISTRATION Please enter your information
*
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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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To print a copy: make sure you have selected Landscape in File/Page Setup > then select File/Print
Enter Items below:
INV#
Item Desc.
Damage Desc.
QTY
CLAIMED $
🛈
COST $
🛈
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