Order Number *

Your Name *

Email *

Phone *

Carrier Name *

UPS, FedEx, SAIA, TForce, etc

Product SKU *

Damaged Qty *

Reason for Claim *

Requested Method of Resolution *

Image of item inside the box, with all original cushioning and packing

Multiple images preferred

temp-for-88383-file2-1_

Image of shipping label with tracking number clearly visible

temp-for-88383-file2-2_

If delivered via LTL, include image of the BOL (Bill of Lading)

Please list details of the lost or damaged package *

If delivered via LTL, please include the following -

1. The appointment day and time you expected the carrier to arrive

2. The day/time the carrier made the delivery (if applicable)

3. Any additional communication you had with the carrier at time of delivery (i.e. refusing delivery due to noticeable damage)

I certify the information provided is accurate and complete *

Your claim has been successful submitted!

One of our team members will be in touch with you shortly.

Your claim has been successful submitted!

One of our team members will be in touch with you shortly.

Regal-Beloit

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