Hercules Inc. Enter New Claim

Enter Freight Claim
Your Ref # Hercules Freight Bill # Claim is for: Damage Loss
Shipper Name	Consignee Name
Bill of Lading Date	Final Destination
Detailed statement showing how amount claimed is determined
Total Amount Claimed: Currency: US Canadian
The following documents will be submitted in support of the claim (please mail separately) Document bearing notation of loss or damage Carriers inspection Report Form Complete invoice or copy showing cost of goods Other (specify):
Additional Comments
Company Name:
Street Address:
City:
State/Prov:
Zip/Postal Code:
Your Name:
Your Phone:
Your Fax: