Kelley Furniture Damage Report Form
Full Name on Order:
Date of Report:
Address:
Phone Number:
Order Number Item Number and/or Auction Number:
Item Arrived VIA (circle one) UPS/FEDEX/RDFS/CENTRAL FREIGHT/ABF
Other___________________
Tracking Number(s) from Shipment
Did Your Furniture Arrive on a Palette?
Yes_____ No____
Did You Note the Damage on the delivery receipt?
Yes_____ No ____ if, no please explain
_____________________________________________________________________________
Describe Damage in Detail. Please Describe Condition of Boxes as well as the furniture itself.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Replacement Part Numbers Needed (off of instruction list)
We will replace only the part listed below. It is your responsibility to verify the accuracy of the parts you are requesting. Any
change in replacements needed after the original replacements needed after the original replacements are shipped, will be
charged to the customer, so please proofread this before faxing.
Part Number
Brief Part Description
___________
_________________________________
___________
_________________________________
___________
_________________________________
___________
_________________________________
PRINT, FILL OUT AND FAX BACK TO
949-837-5588
We apologize for your inconvenience and look forward to working together with you to
come to a swift and reasonable solution.
