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The following statement of facts is hereby certified to be correct
Claimant Information (* - Mandatory)
Company
*
Address
*
Address (Cont'd)
City
*
Prov/State
*
Province/State
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Nova Scotia
Northwest Territories
Nunavut
Ontario
PEI
Quebec
Saskatchewan
Yukon
ALASKA
ALABAMA
ARKANSAS
ARIZONA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF COLUMBIA
DELAWARE
FLORIDA
GEORGIA
IOWA
IDAHO
ILLINOIS
INDIANA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSOURI
MISSISSIPPI
MONTANA
NORTH CAROLINA
NORTH DAKOTA
NEBRASKA
NEW HAMPHIRE
NEW JERSEY
NEW MEXICO
NEVADA
NEW YORK
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VIRGINIA
VERMONT
WASHINGTON
WISCONSIN
WEST VIRGINA
Postal
*
Contact Name
*
Email
*
Phone
*
-
-
x-
Claim and Shipment Details
Commodity
*
---Commodity Type---
ABRASIVES
ACIDS
AIR COMPRESSORS
AIR CRAFT ENGINES
AIRCRAFT PARTS
ALCOHOLIC BEVERAGES
AMMUNITION
ANIMAL FEED
APPLIANCES, ELECTRIC
AUTO, BUS, TRUCK PARTS
BAKERY GOODS
BATTERIES, WET DRY
BEDS, BEDDING
BEER, MALT LIQUOR
BELTING
BEVERAGES, NON ALCOHOLIC
BLACKBOARDS
BLOOD, LIQUID OR PLASMA
BLUE PRINT PAPER
BOATS, PARTS, ACCESS
BOILERS
BOTTLES
BUILDERS' HARDWARE
BUILDING MATERIAL
BUILDINGS PORT/FABRICATED
CABINETS, SU, OR KD
CABLE
CAGES
CAMERAS, PHOTO EQUIPT
CANDY & CONFECTIONERY
CANNED FRUIT
CANNED VEGETABLES
CARBOYS
CARPETS, RUGS
CARTONS, KD
CARTS
CASH REGISTERS
CASKETS
CASTINGS & DIES
CEMENT
CERAMIC TILE
CEREAL PRODUCTS
CHAIN
CHEESE
CHEM & ALLIED PRODUCTS
CHINA
CIGARETTES, CIGARS
CLEANING COMPOUNDS
CLOTHING EXCEPT FUR
COFFEE
COUPLINGS
CUTLERY
CYLINDERS
DECORATIONS
DISHES
DISPENSING MACHINES
DISPLAYS, ADVERTISING
DOORS
DRUGS, MEDICINES
DUCTS, CABLE OR INSULATOR
DYES & PIGMENT
EARTHENWARE, POTTERY
ELECTRIC MACHINE EQUIP
ELECTRIC MOTORS
ELEVATORS & PARTS
EXPLOSIVES
FABRICS, SYNTHETIC
FARM MACHINE PARTS
FENCING
FERTILIZER
FILM
FIRE EXTINGUISHERS
FIREARMS, SMALL ARMS
FISH, FROZEN OR CANNED
FLAGS
FLARES
FLOUR, GRAIN
FOOD ALLIED PRODUCTS
FOOD, PRESERVED
FRAMES
FROZEN FRUITS, VEGETABLES
FURNITURE, HOUSEHOLD
FURNITURE, OFFICE
FURS & FUR GOODS
GASES
GAUGES
GEARS
GENERATORS
GLASS, BENT OR FLAT
GLASS, LAMINATED PLATE
GLASSWARE, GLASS PRODUCTS
GLUE
GREASE
HIDES, PELTS & LEATHER
HOSE
HOSPITAL GOODS
HOUSEHOLD GOODS
HRDWR. EXCEPT POWER TOOLS
INGOTS
INSECTICIDES
INSTRUMENTS, LABS
JEWELRY, SILVERWARE
JUICES, FRUIT OR VEG
LADDERS
LAMP BLACK
LAMPS, SHADES, ELECTRIC
LIGHTING FIXTURES, LENSES
LIQUOR DISTILLED
LUMBER
MACHINERY
MAGAZINES & BOOKS
MARBLE & STONE
MEAT
METAL PRODUCTS
MIRRORS
MOULDS
NOVELTIES
NUTS, EDIBLE
OFFICE MACHINES
OFFICE SUPPLIES
OILS
OPTICAL LENSES
ORDNANCE
PAINTINGS, PICTURES
PAINTS, VARNISHES
PALLETS, MT
PAPER BAGS
PAPER PRODS, STATIONERY
PIPE
PLANTS, LIVE
PLASTIC & RUBBER
PLUMBERS' GOODS
PLUMBING, HEATING FIXT
POOLS, SWIMMING & PARTS
PRINTED MATTER/ADVERT
RACKS, RACKING
RECORDS, STEREO
RUBBER, CRUDE
SAFES, VAULTS
SHEET METAL
SHEET MICA, ETC
SHELVING
SHINGLES
SHOES, BOOTS
SOAPS, DETERGENTS
SPORTING GOODS
SPRINGS
STRAPPING
SYNTHETIC RESIN MAT'LS
TEXTILE PRODUCTS
TEXTILE YARN
TEXTILES WOVEN
TIRES, TUBES
TOBACCO PRODUCTS
TOILET PREPS.
TOOLS, POWER
TOYS, GAMES
TV, RADIOS, STEREO EQUIP
WALLPAPER
WATCHES, CLOCKS
WAX
WIRE, ELECTRICAL
NFF Pro No
*
All Amounts Are
*
CDN Dollars
U.S. Dollors
Your Reference No
*
Quantity
*
Description
Unit Cost
*
Type
Shortage
Damage
Shortage
Damage
Shortage
Damage
Shortage
Damage
Shortage
Damage
Amounts must include all applicable discounts
Remarks and Comments
If the claim involves damaged goods, you must check one or more of the following:
Damaged goods can be repaired for approximately:
Damaged goods can be used as is for an allowance of:
Damaged goods are available for pickup.
Damaged goods are NOT available for pickup (please explain below).
*
If you have supporting documents, please submit them here. Allowable document types are Adobe Acrobat(PDF), color images (JPG).Please try to keep the combined size of all documents below about 10 Mb. Additional documents can be submitted later using information provided when confirmation Is emailed to you.
-- Please Select Document Description --
Complete copy of supplier's original invoice
Complete copy of customer billing invoice
Signed price certification on stock transfers only
Itemized repair bill showing parts and labor breakdown
Carrier inspecion Report and Images
Invoices verifying customs and/or brokerage fees
-- Please Select Document Description --
Complete copy of supplier's original invoice
Complete copy of customer billing invoice
Signed price certification on stock transfers only
Itemized repair bill showing parts and labor breakdown
Carrier inspecion Report and Images
Invoices verifying customs and/or brokerage fees
-- Please Select Document Description --
Complete copy of supplier's original invoice
Complete copy of customer billing invoice
Signed price certification on stock transfers only
Itemized repair bill showing parts and labor breakdown
Carrier inspecion Report and Images
Invoices verifying customs and/or brokerage fees
-- Please Select Document Description --
Complete copy of supplier's original invoice
Complete copy of customer billing invoice
Signed price certification on stock transfers only
Itemized repair bill showing parts and labor breakdown
Carrier inspecion Report and Images
Invoices verifying customs and/or brokerage fees