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Claim Form

Please make sure you have reviewed our Claim Form Instructions before proceeding.

* Required Fields.

Carrier Order Number:*
(To file your claim on-line, YOU MUST REFERENCE YOUR CARRIER ORDER NUMBER. It is located in the upper right corner of your Order for Service or Bill of Lading.)

Name:*

Phone:*

Mobile Phone:

E-mail:*

Street Address:*

City:*

State:*

ZIP:*

Item 1

Inventory Number:* (This is found on the Household Goods Descriptive Inventory form)

Name/Description of Article:* (Appliances, electronic equipment – requires manufacturers’ name, model and serial number. China, Crystal, Statuary – requires manufacturer’s name, number, or other identification. Include colors, full description.)

Nature of Claim:* (whether damaged or missing, type of damage, etc.)

Estimated Weight:*

When was the item purchased:*

Purchase Price:*

Estimated Replacement Cost:*

Amount Claimed:*

Was the item packed properly?*

Was the carton damaged when you received it?*

General Comments:

: Questions?

Tip #5: Encourage them to label and draw on the boxes for their room contents. Let them add notes for the driver. While they’re having fun, you can do some packing.

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