Claims Request Form
Please complete all fields in order to have your claim processed in a timely manner. (Use the TAB key to move through the form.)
Please include a color photograph(s) which clearly show(s) the defect and the container label.
Questions: Call Matt Bianchi at 209-826-9494 x 108 or email
mattb@ingomar.com
Ingomar will review your request and advise you of the status of your claim via a “Claim Status Summary” acknowledgement.
Until receipt of an approved “Claim Status Summary” acknowledgement, claim(s) will be considered pending and not valid.
Claim Information
Date of Claim:
Contact Person:
required
Contact Email
required
BOL Number (s):
Product:
Product Code:
Company Name:
required
Customer Claim No:
Contact Number:
required
Container Lot Number (s):
Photos
Maximum size is 5mbs combined.
Attach Photo
Attach Photo
Attach Photo
Attach Photo
Attach Photo
Description of defect:
Claim Calculation
Total lbs of claim:
Product Cost (price per lb, must equal Ingomar’s invoiced price)
$
Total Product Cost = (Total lbs x Product Cost)
$
Freight Charges: (if applicable)
$
Disposal Charges (if applicable):
$
Bin Charges (if approved):
$
Other Charges:
$
Total Claim Requested:
$
