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Back to Forms for 'Warehouses'.





Agreement made __________ (date) between __________ (claimant), of ___________ ____________________ (address), ______________ (city), ______________ County, __________ (state), referred to in this agreement as claimant, and ________________ (warehouseman), of _______________________________ (address), ____________ (city), _____________ County, _____________ (state), referred to in this agreement as warehouseman.




1. On __________ (date), claimant stored with _____________ (warehouseman), at _____________________________________ (address), _________________ (city), __________ County, _________ (state), certain goods consisting of _____________ (describe goods).


2. Warehouseman issued to claimant its original warehouse receipt no. __________ on delivery of such goods by claimant.


3. Claimant has lost or mislaid such warehouse receipt, and the same has not been negotiated by claimant nor has it passed from __________ (his or her) possession knowingly.


In consideration of delivery to claimant of the above described goods by warehouseman, without claimant's surrender of the above-mentioned warehouse receipt, claimant does hereby indemnify warehouseman against all loss, damages, charges, or other expenses reasonably incurred by warehouseman by reason of claimant’s failure to return such warehouse receipt on surrender by warehouseman of such goods.


In witness whereof, the parties have executed this agreement at __________ (designate place of execution), on __________ (date).



Name of Claimant






By: _________________________

(Signature of Authorized Agent)





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