Danica Claim Form

Hello!

We are sorry your products didn't arrive as expected. Let us make it right!

Please fill out the form below and, once approved, your credit will be emailed to the contact on your account who is set up to receive invoices.

Disclaimer

All discrepancies must be reported within 5 days of receipt of goods.

Returns will not be accepted for in store damage or overstocked merchandise. If your claim requires a physical return, a Customer Service Specialist will contact you within 5 business days to arrange a return call tag. Returns sent back without prior Customer Service authorization may be refused and credit may not be issued.

Account Number*

Store Name*

Contact Name*

Email Address*

Phone Number*

Fax Number

Invoice or Sales Order Number

Order Date

Sales Rep Name

Sales Rep Email

Please clearly indicate the problem with the product by selecting the appropriate reason code.

Item Number*

Item Description*

Quantity*

Claim Reason*

General Comment

Quality Issue Details*

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error?*

How many items did you receive in error?*

Click here to add more items

Item Number*

Item Description*

Quantity*

Claim Reason*

General Comment

Quality Issue Details*

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error?*

How many items did you receive in error?*

Click here to add more items

Item Number*

Item Description*

Quantity*

Claim Reason*

General Comment

Quality Issue Details*

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error?*

How many items did you receive in error?*

Click here to add more items

Item Number*

Item Description*

Quantity*

Claim Reason*

General Comment

Quality Issue Details*

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error?*

How many items did you receive in error?*

Click here to add more items

Item Number*

Item Description*

Quantity*

Claim Reason*

General Comment

Quality Issue Details*

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error?*

How many items did you receive in error?*

Click here to add more items

Item Number*

Item Description*

Quantity*

Claim Reason*

General Comment

Quality Issue Details*

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error?*

How many items did you receive in error?*

Click here to add more items

Item Number*

Item Description*

Quantity*

Claim Reason*

General Comment

Quality Issue Details*

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error?*

How many items did you receive in error?*

Click here to add more items

Item Number*

Item Description*

Quantity*

Claim Reason*

General Comment*

Quality Issue Details*

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error?*

How many items did you receive in error?*

Click here to add more items

Item Number*

Item Description*

Quantity*

Claim Reason*

General Comment*

Quality Issue Details*

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error?*

How many items did you receive in error?*

Click here to add more items

Item Number*

Item Description*

Quantity*

Claim Reason*

General Comment*

Quality Issue Details*

Please claim the item you did not receive. Then note in the following fields what you received instead.

Which item did you receive in error?*

How many items did you receive in error?*

Upload photos of damages, if applicable

Danica Claim Form

CUSTOMER AND ORDER INFORMATION

CLAIM DETAILS

Claim 1

Claim 2

Claim 3

Claim 4

Claim 5

Claim 6

Claim 7

Claim 8

Claim 9

Claim 10