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*Claim Amount $:
*Was the Damage Noticed at Time of Delivery?YesNo
Was the Packaging CrushedPuncturedTornOther
Description of Damage
*Name of Claimant Company
*Signature of Claimant(First and Last Name):
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*Bill of Lading
*Packing Slip listing all of the products that were shipped
*Supplier’s Invoice showing cost of goods and all discounts associated
*Invoice to GX with the final amount for the claim
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