Standard Form For Presentation Of Loss And Damage Claim
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2Standard Form for Presentation of Loss and Damage Claim
Mail
To:
Old Dominion Freight Line, Inc
500 Old Dominion Way
Date: _______________________
Thomasville, NC 27360
FAX CLAIMS TO:
336-822-5494 or 336-822-5010
This claim for $______________ is made against your company for:
Shortage
Noted Damage
Concealed Damage
Theft
Other
Shipper: _____________________________
Consignee: ______________________________
Date of Bill of Lading: ___________________
Date of Delivery: __________________________
Pro or Waybill Number: __________________
Claimant's Claim Number: __________________
(not required)
Detailed Statement Showing How Amount of Claim is Determined
(Number and description of articles, nature and extent of loss or damage, invoice price of articles, amount
of claim, etc. ALL DISCOUNT and ALLOWANCES MUST BE SHOWN
$0.00
Total Amount Claimed:
The following documents are submitted in support of this claim (if applicable):
Original Bill of Lading
Original vendor's invoice and/
or repair invoice
Original Delivery Receipt
Other supporting documents
Company Name: ____________________________
Remit to (if different): ____________________________
Attention: __________________________________
Attention: _____________________________________
Mailing Address: ____________________________
Mailing Address: _______________________________
City/State/ZIP: ______________________________
City/State/ZIP: _________________________________
Signature: ________________________________
Telephone: ___________________________________
Email: ___________________________________
Fax: _________________________________________
Please DO NOT fax photos! Please fax your form to the FAX number at the top right of this form. Photos may be
mailed to the address above or emailed to . Any questions, please contact the Claims
Department at 800-825-6636 or Corporate Customer Service at 800-235-5569.
You have 9 months from the date of delivery to file a claim. Old Dominion has 30 days to acknowledge a claim in writing and 120 days
to process. Please be patient during this time.
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