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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.

 
 

LDW Incident Form

Items followed by an asterisk (*) must be completed to submit this form.

  Collision
  Fire
  Hail
  Lightning
  Theft
  Vandalism
  Windstorm
  Yes
  No
  Yes
  No
  Yes
  No
  Employee/company driver
  Leased owner operator
  Other
  Yes
  No
  Yes
  No
  Yes
  No
  Yes
  No
  Yes
  No
  Yes
  No
Note: File upload allowed limit is 2MB
If the police report is not available at the time of this submission, provide the police report number.

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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