Please fill out the form below to request a claim with The Dependable Companies.
Fields marked with (*) are required to process the request.

Date	*
Claimant's Reference	*
Freight Bill Number	*
This claim is being filed by:
Claims Code
		If you file three or more claims with Dependable per month, you can obtain a "Claims Code" which will expedite the filing process. Please call 323-526-2222 Ext. 3071 for assistance.
Company Name	*
Contact Person	*
Address	*
City	*
State	*	Alabama Alaska Arizona Arkansas California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code	*
Phone	*
Fax
Email Address	*
Re-enter Email Address	*
Shipper Information
Name	*
Address	*
City	*
State	*	Alabama Alaska Arizona Arkansas California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code	*
Phone	*
Fax
Email Address
Consignee Information
Name	*
Address	*
City	*
State	*	Alabama Alaska Arizona Arkansas California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code	*
Phone	*
Fax
Email Address
Detailed statement showing how the claimed amount is determined
*    *  $      $      $      $      $     Total Amount of Claim:   *  $
What kind of loss? (Click down arrow) *  Damage Shortage Damage and Shortage Other If this is a damage claim, please complete the following three questions.       Is the freight available for inspection?   No Yes       Is the freight available for salvage?   No Yes       Is the original packaging material available?   No Yes
The following documents are submitted in support of this claim: Valid attachment file types: *.txt, *.jpg, *.doc, *.pdf
**Copy of Bill of Lading
**Copy of Delivery document
Copy of Original Invoice	*
Copy of Inspection Report
Other document 1, i.e., photo
Other document 2
**It is highly recommended that you include these documents with your claim to expedite processing.
Comments (Max. 100 characters)
Please read the Notice to Claimants (.pdf format).
I have read the "NOTICE TO CLAIMANTS" and are submitting this claim to your company. I understand that I will receive an email verifying this information has been received by your company, and that I will receive a formal acknowledgement within two weeks in the mail.
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