Cargo Loss and Damage Claims

Name: (i.e., John Doe)
This field is required.

Actual Receiver/Warehouse:

Company:

Address/City/State/Zip:

E-mail Address: (i.e., jdoe@example.com)
This field is required.

Phone:
This field is required.

Reporting Initial:

Reporting Number:

Billing Date:

Items Damaged:

Value: $

Door Seals Intact? Select One... Yes No

Photos Taken? Select One... Yes No
Send digital photos to BNSF. Remember to include car or van number in subject line of your email.

Securement Method: Select One... DID Bags Wood Blocking Rubber Mats Banding Ty-Gard LD Doors Bulkhead None Unknown Other

Repetitive Damage Problem? Select One... Yes No

Cause of Damage: Select One No Bracing Improper Loading / Bracing Defective Equipment Preload Damage Truck Handling Rail Handling Theft/Vandalism Packaging Other Unknown

Damage Description:

Company:

Claimant's File:

Contact Person:
This field is required.

E-mail:
(i.e., jdoe@example.com)
This field is required.

Phone:

Address:

State, City, St Zip:

Initial:

Number:
(railcar/van/container)

Shipper:

Origin:
(City St)

Receiver:

Destination :
(City St)

Billing Date (mm dd yyyy): Month: Day: Year:

Unloading Date (mm dd yyyy): Month: Day Year:

Total Claim Amount:   $ (attach supporting invoices to email)

Reason for Claim? Select one Shortage Damage

Carrier Previously Notified? Select one Yes - BNSF Yes - Other Carrier No

Photos Taken? Select one Yes No
Send digital photos to BNSF. Send e-mail attachments to BNSF with your claim (i.e., digital photos, invoices, unloading reports). Please remember to include the car or van number in the subject line of your e-mail.

Items Damaged/Short - Description and Value:

Disposition of Damaged Lading:

Comments: