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Damaged Claims Form

Shippers First Name

Shippers Last Name

Recipient First Name

Recipient Last Name

Recipient Street Address

Recipient Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

UPS Tracking Number

Phone

Proof of Value Image

Proof of Value Document

Pickup or Drop Off Date

Number of Damaged Items

Total Items Sent

Damage Claim Amount

Damage Description

Images of Correnpondence with Recipient

Documents of Correspondence with Recipient

Photos of Damaged Item/s

Photos of Packaging

Available to Inspect?

Yes No

Where is the package currently?

Additional comments