Claim Form

To fill out this Statement of Claim form, you will need to reference your copy of the following items:

  1. Household Goods Carrier’s Bill of Lading and Freight Bill.
  2. Household Goods Descriptive Inventory.

In all cases, keep damaged articles (including shipping containers) for inspection. Arrangements will be made to inspect and estimate damage to the articles you have claimed.

Do not repair or replace any damaged items or cartons that they were contained in. All items must be inspected by our representative before we can accept liability for any damage done during your move.

Please be advised that for interstate (long distance) moves, you only have NINE MONTHS from the date of delivery to complete and send this form to our office. And for local/intrastate/perm storage moves, you only have ninety days to notify us of a claim and FOUR MONTHS from the date of delivery to complete and send this form to our office. The carrier must receive the claim form within the stated filing period.

Note: All items denoted with * are required.

Customer Information
Where did you move to?
Where did you move from?
Present Address
Additional Information

If ’YES’ then where?

What type of valuation was the shipment moved under?

Please enter the information regarding the item you wish to claim. To be processed correctly, the claimed item must include an Inventory Item number OR if your claim resulted from a local or Intra-state move, there may not be any inventory number associated with your claim.

NOTE: If the item is repairable but you will accept a nominal cash allowance instead of repairs, enter the amount you are requesting. If repairs are preferred, click the "repair" box. Arrangements may be made to inspect the claimed item. However, please enter a dollar amount claimed and/or click the repair box for every item claimed.

When you are ready to add another item to the Claim Form, please click on the ’Click Here to Add Another Item’ button.

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