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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 #3: Take time as soon as you know you're planning to move to obtain copies of records you will need for service providers, i.e. medical, dental, vision, veterinary, school, etc. Take care of these things before you become busy with packing and all the other details.

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