We care about your move! Please fill out the following claim form as accurately as possible. Once you have finished please submit the claim form by clicking on the "submit" button. Our Claims Department will handle your claim promptly and equitably. We appreciate your business and sincerely hope to make the filling and settling of your claim as simple as possible.

Taking a moment to review the following information will help expedite your claim:

• It is important to remember that all claims must be submitted in writing or emailed with the following online form. Please contact your move counselor to find out how long you have to file your claim.
• Please make sure that you are fully unpacked and have gone through your entire shipment. The submission of this form constitutes your complete and final claim.
• Please provide a detailed description including extent, location and nature of damage.
• Please retain the damaged articles, including shipping cartons. These items must be available for inspection. Please do not attempt to repair items prior to inspection.
• Please make sure that you are fully unpacked and have inspected your entire shipment. Submission of this form constitutes your complete and final claim.
• Prompt settlement requires: Inventory Number, Article, Approximate purchase date, Approximate purchase price, Amount claimed

First Name:
Last Name:
Delivery Address:
Apt/Suite#:
City:
State:
Zip Code:
If different from above:
Mailing Address:
Email:
Phone Number:
Work Number:
Cell Number:
Employer Pay For Move?	- Yes No
Name of Employer:
Carrier Reference #:
Pickup Date:
Delivery Date:
Origin Address:

Please use the tab key to move throughout the grid below. If you click on the enter key it will submit the form. Once you are finished, please click the submit button below or hit the enter key on your keyboard to submit the form to the claims department.

Inventory Number	Article Name	Damage Description	Purchase Date	Purchase Price	Claim Amount	Carton Damage
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No
						Yes No