LMD

Damage / Inconvenience

Allowance Form

Damage / Inconvenience Allowance Request

LMD Carrier Information

Employee Name*

Employee Phone*

Carrier Code*

Customer Information

First Name*

Last Name*

Address 1*

Address 2

Zip Code*

City*

State*

Cell Phone

Alt Phone

Email Address

DA/IA Information

Type of Allowance

Reason*

Product Type*

PO #*

Brief Explanation of Allowance Request*

Damaged Picture (at least 4 pictures including serial number picture)

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