Please provide the following information:

Your Company Name
First Name
Last Name
Primary Contact Email
Primary Contact Phone
Your Claim Number
Customer Internal Reference Number (optional)
Bill of Lading Number
P.O. Number (Optional)
Western Express PRO # (Optional)
Western Express Truck Number (Optional)
Western Express Trailer Number (Optional)
Date of Shipment
Date of Incident
Claim Amount
* Please describe the incident.
Please provide as much documentation as you can below. Please note these should either be PDFs, JPGs, or PNGs. Excel and word documents should be converted to any of the formats previously listed. Thank you!
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