Claim Form
Tracking Number
*
Claim Reason
*
Please Select
Lost
Damage
Item Details
Item Name
*
Item Type
*
Please Select
Cash/Certificate
Jewelry
Clothing/Home Products
Arts/Crafts
Media, Music/Video
Electronics
Computers
Collectibles
Sports Equipment
Liquor/Wine
Animals
Document Reconstruction
Firearm
Hazardous Material
Event Tickets
Other
Specific Item Type
*
Item Description (Brand, Size(Inch), SKU, Color, Model Number)
*
Unit Price (USD)
*
Quantity
*
Photo of Item
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Photo of Damaged Item (If the claim reason is Damage)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
More Item(s) to add?
Yes
No
Item 2
Item2 - Name
*
Item2 - Type
*
Please Select
Cash/Certificate
Jewelry
Clothing/Home Products
Arts/Crafts
Media, Music/Video
Electronics
Computers
Collectibles
Sports Equipment
Liquor/Wine
Animals
Document Reconstruction
Firearm
Hazardous Material
Event Tickets
Other
Item2 - Specific Type
*
Item2 - Description (Brand, Size, SKU, Color)
*
Item2 - Unit Price (USD)
*
Item2 - Quantity
*
Item2 - Photo of Item
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Item2 - Photo of Damaged Item (If the claim reason is Damage)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Item2 - More Item(s) to add?
Yes
No
Item 3
Item3 - Name
*
Item3 - Type
*
Please Select
Cash/Certificate
Jewelry
Clothing/Home Products
Arts/Crafts
Media, Music/Video
Electronics
Computers
Collectibles
Sports Equipment
Liquor/Wine
Animals
Document Reconstruction
Firearm
Hazardous Material
Event Tickets
Other
Item3 - Specific Type
*
Item3 - Description (Brand, Size, SKU, Color)
*
Item3 - Unit Price (USD)
*
Item3 - Quantity
*
Item3 - Photo of Item
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Item3 - Photo of Damaged Item (If the claim reason is Damage)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Section Divider
Purchase Information
Proof of Value (Invoice)
Browse Files
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Choose a file
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of
Replacement Package Information
Has a replacement package been shipped?
Yes
No
Replacement Tracking Number
Do you plan on shipping a re placement package?
Yes
No
Recipient Contacts
Recipient's Email
example@example.com
Recipient's Phone
*
Please enter a valid phone number.
Requestor
Requestor's Company
*
Requestor's Email
*
example@example.com
Submit
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