Damage Claim Form

Today's Date

Mail:

Plastilite Corporation

4930 Battlefield Drive Omaha, NE 68152

Email:

info@plastilite.com

Fax:

402-571-6739

This claim is for:

Shortage

Damage

Concealed Damage

Other

If you selected other, please explain below:

Was product shortage / damage noted in writing at time of delivery?

Yes

No

If yes, please provide a copy of the delivery receipt:

Choose file

Date of Delivery:

Your PO #:

Shipping/BOL #:

Plastilite Order #:

Plastilite Invoice #:

Company Name:

Contact Name:

Contact Phone:

Contact Email:

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