Customer Portal
MidSouth Material Claim Form
Customer:
Customer Claim Number:
Contact Info:
Customer Claim Date:
Product Information
Samples of Defect
Gauge:
Sent (Date):
Width:
Original Coil Weight:
Color:
Current Metal Location:
Coil Number:
Description of Defect:
Purchase Order:
Rejected Coil (lbs):
Invoice:
Rejected Slit Coil (lbs):
Purchase Price:
$
Rejected Sheet/Blanks (lbs):
Current Scrap Rate:
$
Total Pounds Rejected:
PRICE
POUNDS
TOTAL
Scrap Value:
$
X
$
Secondary Value:
$
X
$
Coil Handling Charge:
$
Claim Value:
$
Discussion / Disposition:
Submit Claim