Metrowest Massachusetts Regional Library System
135 Beaver Street
Waltham, MA 02452
Phone: 781-398-1819 Fax: 781-398-1821 e-mail: metroweb@mmrls.org
DAMAGE CLAIM FORM
Today’s date: ___________________ Date of incident: _______________________
Library: ______________________________________________________________
Contact: ______________________________________________________________
Phone: _______ __________________Email address: _________________________
Author: _______________________________________________________________
Title: _________________________________________________________________
Check if item is: Book ________ Video _______ Other (describe) _______________
Item sent from: _________________________________________________________
Other relevant information: ________________________________________________
Please note: In accordance with Metrowest’s reimbursement policy, the damaged item must accompany the claim form. Metrowest staff will make a determination of the replacement cost. For additional information regarding Delivery Policies check out the Delivery link on our web site.