PRESENTATION OF SHORTAGE OR DAMAGE CLAIM. Dohrn Transfer Company. 625 3rd Avenue. Rock Island, IL 61201 ph. 800-747-0723 fax 309-794 -1693. No. Pieces...
BLIND SHIPMENT FORM. Please provide the following information and send to us along with your bill of lading for final delivery to fax number (309) 794-1693 or e-mail [email protected]. PLEASE UNDERSTAND – THIS IS NOT A BILL OF LADING AND SHIPM
From the property described below, in apparent good order, except as noted ( contents and condition of contents of packaged unknown), marked, consigned, and destined as indicated below, which said company. (the word company being understood throughou
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100% of Iowa (IA). 100% of Illinois (IL). 100% of Indiana (IN). 100% of Missouri ( MO). 100% of Nebraska (NE). 100% of Wisconsin (WI). Dohrn Transfer Company - Direct Serviced Points. Partial Coverage of KS, MN, SD and WY: Zip. Primary City. State. T
A brief recap of accessorial charges and special services as found in Dohrn Transfer Company Rules Tariff DHRN 100 series is listed herein for informational purposes. Exact wording and detailed applications for other governing rules will be found in.
INSURANCE COVERAGE. In order that subrogation claims may be adjudicated, it is essential that the claimant provide the following information regarding the insurance
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3. AUTHORITY – Provide details regarding your authority to complete a claim for the missing bonds. YesAre you named on the bonds? NoIf , skip to Item 4
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PRESENTATION OF SHORTAGE OR DAMAGE CLAIM
DOHRN Transfer Company This claim is for
This claim is presented to Dohrn Transfer Company
SHORTAGE DAMAGE
625 3rd Avenue Rock Island, IL 61201 ph. 800-747-0723 fax 309-794-1693
CLAIMANT
Date Claim Filed
Company Name
Claimants Reference No.
Address 1
Dohrn Freight Bill No.
Address 2
Please refer to this freight bill number on all correspondence.
City
State
Zip
Bill of Lading Date
Phone
Weight of Shipment
SHIPPER
CONSIGNEE
Company Name
Company Name
Address 1
Address 1
Address 2
Address 2
City
State
Zip
City
State
Zip
STATEMENT OF SHORTAGE OR DAMAGE No. Pieces
Description of articles, including part no., model no., etc
Total amount claimed:
Claim is for:
FULL VALUE
Amount Claimed
REPAIR
ALLOWANCE
Be sure to attach letter of explanation if there are special circumstances we should know about regarding your claim.
THE FOLLOWING DOCUMENTS MUST BE INCLUDED TO PROCESS YOUR CLAIM For shortage claim, items 1 through 3 are REQUIRED. For damage claim, items 1 through 6 are REQUIRED.
1. 2. 3. 4. 5. 6.
Original vendors invoice (proof of purchase cost) or photocopy showing all discounts. (Please include entire invoice.) Legible copy of freight bill or original paid freight bill if available. Original bill of lading or bond of indemnity in lieu thereof. Carriers inspection report, where copy has been provided. Invoice for repair or recoopering, showing breakdown of labor by hour and rate of pay, if available. Invoice for materials purchased to complete repair or recoopering, if applicable.
NOTE: In the case of non-delivery or shortage, it will speed conclusion if claim includes a signed statement from the consignee certifying the goods claimed short have never been received from any source and further, notification will be given to the carrier to whom this claim was presented in the event said goods are ever received in the future.
The claimant certifies the foregoing to be correct, and agrees to indemnify the carrier against loss in the event the original Bill of Lading and / or original freight bill are not submitted. SIGNATURE OF CLAIMANT
THE ABOVE FORM MUST BE ENTIRELY COMPLETED FOR CLAIM TO BE PROCESSED.
