Vendor Claim Form

PT Booking Number (from the BOL) *


Select a Shipper Program *
Longs DistributionTarget DistributionWalgreens DistributionPacific Transfer Neighbor Island Consolidation

Retail Store Number (if applicable)


Destination City *
Honolulu, OahuKapolei, OahuMililani, OahuPearl City, OahuWaipahu, OahuKahului, MauiKailua-Kona, HawaiiHilo, HawaiiLihue, KauaiOther (see line below)

If 'Other' Please Tell Us Where Your Shipment Was Destined


Shipper Name *


Shipper Address *


Shipper City *


Shipper State *
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonIllinoisIndianaIowaKansasKentuckyLouisianaMainePennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Shipper Zip / Post Code *


Contact Name *


Contact Email *


Contact Phone Number *