CARGO CLAIM
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Complete all Fields
Name of Insured
Contact Name
Date of Loss
Shipper's Name & Telephone #
Load Picked Up At
Date Loaded
Consignee Name & Telephone #
Load Delivered To
Delivery Date
Description of Cargo
Estimated Loss
Cargo Can Be Seen At
Driver's Name
Address
Driver's Telephone Number
Year, Make & Serial # of Tractor
Towing Company Name
Towing Company Address
Towing Company Phone
Description of Loss
This Information Reported By:
Turner & Hamrick, LLC 2001
