REPORT A LOSS TO US

"*" indicates required fields

Step 1 of 2 - Order Details

ORDER DETAILS

Tell us which order you experienced a loss on.

Name*

Email*

Phone*

Order Number*

Select A Loss Type:*

Desired Solution*

Date Received*

Time Received*

Upload Image of Packing Label*

Drop files here or

Max. file size: 3 GB.

BREED DETAILS

Now let us know how many of each breed you lost on this order.

Breed 1*

Live Count - Breed 1*

Enter "0" if never received

Sex - Breed 1*

Upload Image of Dead Poultry - Breed 1*

Please upload ONE (1) image of ALL your dead poultry for this breed.

Drop files here or

Max. file size: 3 GB.

Would You Like To Add Breed 2?*

Breed 2*

Live Count - Breed 2*

Enter "0" if never received

Sex - Breed 2*

Upload Image of Dead Poultry - Breed 2*

Please upload ONE (1) image of ALL your dead poultry for this breed.

Drop files here or

Max. file size: 3 GB.

Upload Image of Dead Poultry - Breed 2*

Please upload ONE (1) image of ALL your dead poultry for this breed.

Drop files here or

Max. file size: 3 GB.

Would You Like To Add Breed 3?*

Breed 3*

Live Count - Breed 3*

Enter "0" if never received

Sex - Breed 3*

Upload Image of Dead Poultry - Breed 3*

Please upload ONE (1) image of ALL your dead poultry for this breed.

Drop files here or

Max. file size: 3 GB.

Upload Image of Dead Poultry - Breed 3*

Please upload ONE (1) image of ALL your dead poultry for this breed.

Drop files here or

Max. file size: 3 GB.

Would You Like To Add Breed 4?*

Breed 4*

Live Count - Breed 4*

Enter "0" if never received

Sex - Breed 4*

Upload Image of Dead Poultry - Breed 4*

Please upload ONE (1) image of ALL your dead poultry for this breed.

Drop files here or

Max. file size: 3 GB.

Upload Image of Dead Poultry - Breed 4*

Please upload ONE (1) image of ALL your dead poultry for this breed.

Drop files here or

Max. file size: 3 GB.

Would You Like To Add Breed 5?*

Breed 5*

Live Count - Breed 5*

Enter "0" if never received

Sex - Breed 5*

Upload Image of Dead Poultry - Breed 5*

Please upload ONE (1) image of ALL your dead poultry for this breed.

Drop files here or

Max. file size: 3 GB.

Upload Image of Dead Poultry - Breed 5*

Please upload ONE (1) image of ALL your dead poultry for this breed.

Drop files here or

Max. file size: 3 GB.

Would You Like To Add Breed 6?*

Breed 6*

Live Count - Breed 6*

Enter "0" if never received

Sex - Breed 6*

Upload Image of Dead Poultry - Breed 6*

Drop files here or

Max. file size: 3 GB.

Please upload ONE (1) image of ALL your dead poultry for this breed.

Upload Image of Dead Poultry - Breed 6*

Drop files here or

Max. file size: 3 GB.

Please upload ONE (1) image of ALL your dead poultry for this breed.

If you have more than six (6) breeds to claim, please submit another form.

Comments

This field is for validation purposes and should be left unchanged.

Valley Farms Hatchery

"An American Homestead Hatchery!"

REPORT A LOSS TO US

ORDER DETAILS

BREED DETAILS