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LOSS DAMAGE WAIVER (LDW) INCIDENT FORM

 

In the event of damage to, or loss of, a trailer enrolled in the Loss Damage Waiver (LDW) Program, an authorized representative of the lessee/customer MUST complete and submit the form below within 48 hours of the incident causing the damage to an enrolled trailer.

 

*= required information

*
*
*
*
*
  
*
*
  
*
*
  
  
  Collision
  Fire
  Hail
  Lightning
  Theft
  Vandalism
  Windstorm
  Yes
  No
  Yes
  No
  Yes
  No
  Yes
  No
  Yes
  No
  Yes
  No
  Yes
  No
  Yes
  No
  Employee/company driver
  Leased owner operator
  Other
*
  
  
  Yes
  No

If the police report not available at the time of this submission, provide the information below:

Upload damage photos, or send by email to [email protected] as soon as available, with Lessee/Customer company name and LDW incident date in the subject line of the email. The following photos are required:
1. photo of the VIN plate      2. photos of all damage      3. photos of the trailer from all sides

Include any documentation to support towing or recovery costs you incurred.

  

By submitting the LDW Incident Form, I affirm that I am a representative of the Lessee/Customer indicated above with authority to submit a LDW Incident Form.

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