Delta Cargo Service Failure Claim

Written complaints/formal claims must be filed within sixty (60) days from the delivery date of the shipment by Delta. A case number will be assigned within 5 business days upon receipt of all supporting documentation as detailed in the instructions for completing claim.

*Required

Reference Information

*Master Air Waybill Number:

*Master Air Waybill Date:

Customer's Reference Number:

Claim Information

*Time Shipped:

*Date Shipped:

*Time Received:

*Date Received:

*Claim Amount (USD):

Airline at Destination:

Booked Flight & Date Arrived:

Flight Taken & Date Arrived:

*Reason for Claim:

Contact Information

*Contact First Name:

*Contact Last Name:

Company Name:

Job Title:

*Address:

Address 2:

*City:

State/Province:

ZIP/Postal Code:

*Country:

*Phone Number:

*Email Address:

*Confirm Email Address:

Terms & Conditions

All claims to be submitted within sixty (60) days after the date of acceptance of the shipment by Delta. Delay submitting could preclude consideration of your claim.

* The foregoing statement of facts is hereby certified as correct

*Type Name Here
(electronic signature):

*Date:

06/19/2013

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