[lblEmailClaimFormDelay]

[LblComment]
[lblClaimFormReview]
Name:	[lblNameDisplay]	Shipment #:	[lblRegDisplay]
Email Address:	[lblEmailDisplay]	Home Phone:	[lblHomePhoneDisplay]
Work Phone/Ext:	[lblWorkPhoneDisplay]	Wireless or Cell Phone:	[lblCellPhoneDisplay]
Current Address:	[lblAddrDisplay]	Mailing Address:	[lblMailingAddrDisplay]
	[lblCityDisplay]		[lblMailingCityDisplay]
Was your shipment stored in a warehouse?		[lblShpmtStrdDisplay]
		[lblAgentCityDisplay]
Move To Address:	[lblMoveToAddr]	Move From Address:	[lblMoveFromAddr]
	[lblMoveToCity]		[lblMoveFromCity]
Overall Comments:
[lblComments]
[lblEmailClaimForm] Items You Have Entered