Mail To: PRIME TIME DELIVERY AND TRANSPORT Ph# 1-800-438-8244 Fax# 828-728-2973
P O Box 1950 Lenoir, North Carolina 28645 Attn: Cargo Claim Department
PRESENTATION OF LOSS AND DAMAGE CLAIMS
CLAIMANT INFORMATION
COMPANY NAME:____________________________________________ AMOUNT OF CLAIM:____________________________
ADDRESS:__________________________________________________ YOUR REFERENCE NUMBER:____________________
CITY,STATE,ZIP:_____________________________________________ DATE OF CLAIM:______________________________
Claim is for:____Shortage____Damage____Concealed Damage
Prime Time's Freight Bill # (PRO #)________________________________ Ack #:________________________________________
Shipper (company)_______________________________________________________(city, state)__________________________________
Consignee (company)____________________________________________________(city, state)__________________________________
Claim must be supported by one or more documents from each of the following categories. Insufficient documentation will delay your claim.
DOCUMENTS REQUIRED IN SUPPORT OF CLAIM- Original Invoice or Certified Copy (All pages)
- Inspection Report(damage claims only)
- Invoice For Cost of Repairs or Parts
- Please itemize repair costs. Include original vendor or sellers invoice for repaired item(s).
- Pictures Must Be Sent on All Damage Items
- Photos of the damaged item & also photos of the carton
If item can be repaired or sold at a discount, please enter that amount here $ _____________________The foregoing statement of facts is hereby certified to be correct, and all copies of invoices attached are also certified to be the exact copies of the original invoice. It is agreed that Caldwell Freight Lines, Inc. and its connections are indemnified against any loss that might arise from payment of this claim without the original paid freight bill and/or original Bill Of Lading.
We appreciate your having selected Caldwell as your carrier. We do every thing in our power to assure that your shipment is delivered to you intact. However, there are times when a claim will occur. If your shipment was delivered short or damaged, we will make every effort to settle your claim in a fair and timely manner.__________________________________________________ __________________________________________________
Claimants Signature Direct Phone Line
__________________________________________________ __________________________________________________
Print name exactly as above in signature Fax #
Prime Time Delivery and Transport
INSPECTION REPORT OF LOSS OR DAMAGE
IMPORTANT-PLEASE DON'T DISCARD THE CONTAINER/CARTON AND ANY PACKING MATERIALS.
*NOTE: If there is more that one item damaged, please complete an inspection form for each item.
To process any claim, we need some basic information about the damage. Please complete all sections. Photos of the
piece and the carton greatly enhance our ability to resolve your claim quickly. Photos may be sent via mail or
e-mail to Becky Hicks or Chris Rash. PLEASE DO NOT FAX PHOTOS.
SECTION 1
Primte Time PRO # _______________________________________ ACK #______________________________________
What is damaged? ITEM#____________________STYLE #____________________
DESCRIPTION (chest, bed, etc....)___________________________________________________________________________
Describe damage (Please be specific)______________________________________________________________________________________________________________Is the container/carton damaged? _____YES_____NO If so, Where?____________________________________________
Were all packing materials intact? _____YES_____NO (please explain)____________________________________________
Is the original container and packing still available? ____YES____NO
Could this problem be a result of a manufacturing defect? ____NO____YES (please explain)______________________________________________________________________________________________________________SECTION 2
Was the freight manufactured in the USA? ____YES____NO
Are there any import markings on the carton, such as "Made in China", etc? ____YES____NO
Please list import markings_________________________________________________________________________________
Could this item be repaired?____Locally____Only by Mfg.____
Can not be repaired because:_____________________________________________________________________________
Can the item be sold at a discount to compensate for damage?
____YES/List disc. amount____________________NO (please explain)_____________________________________________
Where was the freight when the damage was discovered? (Please be as specific as possible)
__________________________________________________________________________________________________________ When was damage discovered?_____________________________ By Whom:_______________________________________
Where is the freight now?___________________________________________________________________________________SECTION 3
Did the packaging (or lack of) cause or contribute to this damage?
____NO____YES (please explain)__________________________________________________________________________ PLEASE DESCRIBE THE PACKING BY CHECKING ITEMS THAT APPLY
FOR CARTONED ITEMS FOR WRAPPED ITEMS
__Corner Pads__YES__NO __Plastic Wrap__YES__NO
__Wooden skid(runners)__YES__NO __Kraft Paper__YES__NO
__Pads under Feet/Legs__YES__NO __Bottom Tray__YES__NO
__Styrofoam Filler__YES__NO __End Caps__YES__NO
Prime Time PRO # (CONT.)________________________________ ACK #______________________________________What was the bottom of the damaged item resting on?__Corrugated pads__Skid__Inside bottom of carton
__Item was suspended in cartonWhat was in between the inside carton sidewall and the product?
__Tissue/foam__Styrofoam blocks __Other(explain)_______________________________________________________________________________________________________________________________________________________________________
What type of packing was on top of the item?
__Tissue/foam__Styrofoam blocks __Other(explain)_______________________________________________________________________________________________________________________________________________________________________Were there any precautionary marking?(e.g.Fragile, This side up, Arrows, etc...)__YES__NO. Please list markings________________________________________________________________________________________________________________Other packing, Please explain____________________________________________________________________________Did the carton have any device such as a shock watch, tip & tell, etc? __YES__NO
If yes, what was the device?_______________________________________________Was it activated?__YES__NOPlease describe your receiving facility
__Truck Height Dock__Ground Level Receiving
__Other(explain)______________________________________________________________________________________ADDITIONAL COMMENTS: ______________________________________________________________________________________________________
______________________________________________________________________________________________________
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______________________________________________________________________________________________________
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______________________________________________________________________________________________________NOTE: This report is merely a statement of facts and does not acknowledge carriers liability. This is not a claim.
Please note that the shipping carton must be held until the claim is resolved. Thank you again for your cooperation.
Inspection done by ________________________________________ Date _____________________