Name: Zip Xpress
Address: 867 Interchange Dr, Holland, Michigan, 49423, United States

Claim Form

Presentation of Loss and Damage Claim

First Name*
Last Name*
Email*
Company Name*
Claimant's Claim No:*
Date Prepared:*
Address:*
Zip Xpress Pro No.:*
Freight Bill Date:*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Ship Date*
MM slash DD slash YYYY
Delivery Date*
MM slash DD slash YYYY
Claim Amount
Please Select*
- Visual Damage
- Shortage
Shipper:*
Consignee:*
Origin:*
Destination:*
Detailed Statement Showing How Amount Claimed For is Determined:
Quantity Description Amount

Please include quantity, item #, nature and extent of the loss. Zip Xpress does not participate in concealed damage claims. All discounts and allowances must be shown. Please click the PLUS button on the right to add more rows.
Applicable Freight Charges*
Total Amount Claimed:*
Documents needed in support of Claim
- Original or copy of paid freight bill
- Original invoice or certified copy
- Carrier's inspection report if inspection done (for damage claims only)
- Repair bill or certified copy if repaired( showing material used & labor rate per hr)
- Weight of damaged or lost items
Please check the fields in which you have provided the appropriate document for (see below). Any claim received without this document is subject to denial based on NMFC Item #300110.
Original or copy of paid freight bill
Drop files here or

Accepted file types: jpg, png, pdf, jpeg, docx, Max. file size: 10 MB, Max. files: 5.
Original invoice or certified copy
Drop files here or

Accepted file types: jpg, png, pdf, jpeg, docx, Max. file size: 10 MB.
Carrier’s inspection report if inspection done (for damage claims only)
Drop files here or

Accepted file types: jpg, png, pdf, jpeg, docx, Max. file size: 10 MB.
Repair bill or certified copy if repaired (showing material used & labor rate per hr)
Drop files here or

Accepted file types: jpg, png, pdf, jpeg, docx, Max. file size: 10 MB.

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Claim Form

Claim Form

Quantity	Description	Amount