Submit a Claim

To submit a claim for a lost or damaged shipment, complete the form below.
Our Claims Specialist will evaluate your request and contact you.

Easily submit your claim here.

* Indicates required field

Giltner Pro/Load # *

Reference # *

Date of Claim (MM/DD/YYYY) *

Claim Type *

Claim Submitted By:

Company Name *

First Name *

Last Name *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Claim Payable To:

Same as Claimant *

Yes No

Company Name *

First Name *

Last Name *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Brief Description of Claim

Claim Amount & How It's Calculated *

Number of Pieces *

Weight *

Pickup Date (MM/DD/YYYY) *

Shipper Name *

Shipper Address *

Line 1

Line 2

City

State

Zip Code

Country

Delivery Date (MM/DD/YYYY) *

Receiver Name *

Receiver Address *

Line 1

Line 2

City

State

Zip Code

Country

Upload Documents

IMPORTANT NOTE: You will need to upload the following documents in each individual upload section as marked. Each section will only allow 1 file to be attached.

Bill of Lading *

Max file size: 20MB

Delivery Receipt *

Max file size: 20MB

Invoice Copy of ALL Items on Shipment (Invoice MUST be the original sales invoice and include date of purchase, invoice number, and detail of items on shipment) *

Max file size: 20MB

Inspection Report *

Max file size: 20MB

Photo Uploads

Photo #1 of item(s) with clear freight damage *

Max file size: 20MB

Photo #2 of item(s) with clear freight damage *

Max file size: 20MB

Photo #3 of item(s) with clear freight damage *

Max file size: 20MB

Photo # 4 of item(s) with clear freight damage *

Max file size: 20MB

Other Documents related to the load and claim

Other File #1 *

Max file size: 20MB

Other File #2 *

Max file size: 20MB

Other File #3 *

Max file size: 20MB

Other File #4 *

Max file size: 20MB

After clicking the submit button, it may take several seconds to upload all files.
Please do not leave the page until you see the confirmation message that your form was submitted successfully.

Submit Claim