Claim Form

Claim Form

Customer Order Claims for McHutchison & Vaughan's Horticulture
Customer Name *
Vendor Name*
Email*
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Claim*

MonthDayYear
Date
Order Number*
Shipment Date*
Order Date

MonthDayYear
Date
Damaged plants/productsIncorrect items receivedQuality issue (e.g., unhealthy plants, pest infestation, poor root structure)Missing itemsOther (please specify)
Item*
Issue*
Ordered Qty*
Claim Quantity*
Item
Issue
Ordered Qty
Claim Quantity
YesNo
Item
Issue
Ordered Qty
Claim Quantity
Item
Issue
Ordered Qty
Claim Quantity
Item
Issue
Ordered Qty
Claim Quantity
Item
Issue
Ordered Qty
Claim Quantity
Item
Issue
Ordered Qty
Claim Quantity
Provide a detailed description of for your claim.
Recipient of BOL (Acknowledged Receipt)

First NameLast Name
Submitted by*
Position*
Attach any relevant photos, receipts, or other documentation supporting your claim

Cancelof
Declaration:

I hereby declare that the information provided in this Claim Form is true and accurate to the best of my knowledge. I understand that providing false information may result in the rejection of my claim. I understand that my claim will be reviewed according to the company’s claim policy.
Claimant's Signature*

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Date Signed*

MonthDayYear
Date
Should be Empty: