Is your claim for a catalog order or online order? (Required)

Seller First Name

Seller Last Name

Seller ID#

Group ID#

First Name

Last Name

Email

Telephone

Extension

Organization

Group/Team

Address 1

Address 2

City

State

Zip Code

For each item row you fill out, please fill out each field: Item number, Catalog Item Number, Description, Quantity, whether the item was listed on the packing slip or not, and whether the item was either missing or damaged. Items reported as missing that were not processed and billed on the original invoice will be processed and billed as late orders and are subject to additional shipping charges. If you are unable to enter your item# , Catalog# or Description below, please contact Customer Service.