Please enable JavaScript in your browser to complete this form.Company *Choice 1Freight LogisticsMidwest BulkLaw TransportationDate *Driver Name *Truck NumberTrailer Number *Axon Trip / Order Number *PO Number *Bill of LadingType of ExceptionOverShortDamagedProduct LossContact name and phone number of reporting partyShipper *Ship Date / TimeDateTimeConsignee *Delivery Date / TimeDateTimeName and phone number of Consignee contactCommodity description of exception *PackagingCartonBundleOtherWas product palletized?Choice 1YesNoQuantity Damaged / ShortValue (if known)Total shipped *Was product rejected by consigneeChoice 1YesNoTotal rejectedType of damage (check ALL that apply)WetCrushedDentedBrokenLeakingLoad ShiftBlocking and BracingChoice 1YesNoLoad LockShrink WrapDunnage BagNoneOtherLocation of damaged productNose of TrailerMiddle of TrailerTail/Door of TrailerThroughoutWet Damage Caused byDispositionDumpedWill ReworkWill deliver as is to ConsigneeNeed repack cartonsOrigin Seal IntactChoice 1YesNoSeal NumbersDriver monitor loading?Choice 1YesNoDriver monitor unloading?Choice 1YesNoTruck / Trailer Accident?Choice 1YesNoTruck / Trailer Stolen?Choice 1YesNoIn the case of Overage, was product accepted by consignee?Choice 1YesNoIf NO, please advise disposition.Comments of any additional informationFile Upload Click or drag a file to this area to upload. File Upload Click or drag a file to this area to upload. File Upload Click or drag a file to this area to upload. File Upload Click or drag a file to this area to upload. File Upload Click or drag a file to this area to upload. File Upload Click or drag a file to this area to upload. File Upload Click or drag a file to this area to upload. File Upload Click or drag a file to this area to upload. File Upload Click or drag a file to this area to upload. File Upload Click or drag a file to this area to upload. PhoneSubmit