OnTrac Claim Form

Submit
Original receipt or invoice of claimed item is required.
Reset
Date:
CONTACT INFORMATION
Company Name
Contact Name
Acct #
State
ZIP
Address
City
Phone
Fax
E-mail
SHIPMENT INFORMATION
Tracking Number
Collect On Delivery (COD): Yes
Ship Date
Signature Required: Yes
No
Invoice #
No
Declared Value
DESCRIPTION OF EVENTS LEADING TO CLAIM
CLAIM SUBMISSIONS
All claims regarding damages to, loss, or
delay of any shipment must be submitted in
writing to the company's office within 30
calendar days of delivery of the shipment.
See Terms and Conditions for more details.
REASON FOR CLAIM
CLAIM AMOUNT
Damage
Value of Item(s)
Loss
Shipping Charges
COD
Other Charges
Other
Total Claim Amount
2501 S Price Rd #201 Chandler, AZ 85286 | P 866.432.4277 | F 602.333.4514 | [email protected]