Claim Form

We are very sorry for any damage that may have occurred during your move. To submit a claim, please enter your information below, and we will get in touch with you as soon as possible.

All fields marked with an asterisk (*) are required.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number(Required)

Work Phone Number

Email(Required)

Order # / Bill of Lading #:

Pickup Date(Required)

Delivery Date(Required)

Origin & Delivery Details

Origin Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Delivery Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Was Shipment in a warehouse?(Required)

Yes

Are you the owner of the goods in question?(Required)

Yes

Have all transportation/storage charges been paid?(Required)

Yes

Claim Item 1

Inventory #(Required)

Article Name(Required)

Description of Damage(Required)

Purchase Price $(Required)

Purchase Date(Required)

Claim Amount $(Required)

Claim Item 2

Inventory #

Article Name

Description of Damage

Purchase Price $

Purchase Date

Claim Amount $

Claim Item 3

Inventory #

Article Name

Description of Damage

Purchase Price $

Purchase Date

Claim Amount $

Claim Item 4

Inventory #

Article Name

Description of Damage

Purchase Price $

Purchase Date

Claim Amount $

Claim Item 5

Inventory #

Article Name

Description of Damage

Purchase Price $

Purchase Date

Claim Amount $

Claim Item 6

Inventory #

Article Name

Description of Damage

Purchase Price $

Purchase Date

Claim Amount $

Claim Item 7

Inventory #

Article Name

Description of Damage

Purchase Price $

Purchase Date

Claim Amount $

Claim Item 8

Inventory #

Article Name

Description of Damage

Purchase Price $

Purchase Date

Claim Amount $

Please Sign Your Name(Required)

Claim Form

Origin & Delivery Details

Claim Item 1

Claim Item 2

Claim Item 3

Claim Item 4

Claim Item 5

Claim Item 6

Claim Item 7

Claim Item 8

Contact us for your FREE in-home or virtual quote

Contact us for your FREE
in-home or virtual quote