Clark & Reid Executive Movers and Relocation Specialists

ONLINE CLAIMS FORM

Completing the following household goods claim form within 90 days of your delivery will assist us in resolving your concerns in an equitable and timely manner. Once submitted, you may check the status of your claim 24/7/365.

* = Required Fields

Clark & Reid Executive Movers
— Online Claims Form —

*Name:		Pickup Date:
Address:		Delivery Date:
City:		*E-mail:
State:	Zip:	*Telephone:


Inventory Number	Description of Article	Description of Claim	Date of Purchase	Original Cost	Replacement Cost	Estimated Cost to Repair/Amount Claimed

Comments or remarks:

By checking this box I attest: 1.) I am the owner of the property described and did not cause or contribute to the damage set forth herein. 2.) That if this claim includes a missing item(s), I agree that I have fully unpacked all the cartons transported during the move. 3.) I will not discard or dispose of any item described in this claim unless I have obtained written authorization. 4.) Only one claim can be filed for my move and any additions or changes to this claim must be made within 48 hours of submittal. 5.) All statements made in this claim and any documents attached are true and correct to the best of my knowledge and belief. 6.) No material information has been withheld.