Application Form - RPM Expedite USA

Evidence of Paid Freight Charges *

RPM invoice must be paid in full and account must be up to date before any claim will be processed.

Verification of Cost *

Document of manufacturer cost OR...
Copy of original invoice for claimed items OR...
Cost of goods as billed to represented customer.

Inspection *

Damage Claims over $500 require an inspection. A copy of the inspection MUST be presented with claim presentation. Claims over $5,000 require a joint 3rd party inspection. To request an inspection, contact claims@rpmexpediteusa.com.

Proof of Loss

if delivered: Copy of Delivery Receipt or POD
If Not Delivered: Copy of Bill of Lading

Type of Claim Being Filed (Select One) *

If "Other" selected, please explain here....

CLAIM FILED BY:

Name *

First

Last

Phone *

Email *

Date / Time *

Company Name/Claimant *

IF CLAIMANT IS 3RD PARTY OR NOT LISTED ON BILL OF LADING, CLAIMANT IS REPRESENTING:

Company / Claimant Reference Number *

SHIPMENT DETAILS FOR WHICH CLAIM IS BEING FILED:

RPM HAWB / PRO Number *

Shipper Name *

Shipper Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of Pick Up *

Consignee Name *

Consignee Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of Delivery *

DETAILED DESCRIPTION OF MATERIAL BEING CLAIMED

Number of Pieces Being Claimed *

Description of Freight Being Claimed *

Material Condition *

New
Old

Total Weight of Freight Being Claimed *

Total Cost of Freight Being Claimed *

Total Amount of Claim *

Customer Login

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Tracking

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888.477.9383

CLAIM FILED BY:

SHIPMENT DETAILS FOR WHICH CLAIM IS BEING FILED:

DETAILED DESCRIPTION OF MATERIAL BEING CLAIMED