Moving Customer - Report of Loss
CUSTOMER FULL NAME
DAYTIME PHONE #
if none, enter store email
MOVER COMPANY NAME
MOVER COMPANY'S ADDRESS
MOVER'S PHONE #
1. Cause of Loss. Was your property damaged by one or more of the following? (check all that apply)
Damage during the act of loading or unloading by mover
Damage during transport resulting from improper packing or loading by mover
2. Please explain what you believe happened to your property:
3. When do you think the damage happened? (Please be specific)
3A. When did your move take place?
3B. When did you discover your loss?
4. Did you notify the mover of the loss? If so, when?
4A. What was the mover's response?
4B. Has the mover already paid a portion of the damage? If so, how much?
THIS SECTION TO BE COMPLETED BY CUSTOMER IMMEDIATELY FOLLOWING THE LOSS.
Items must also be listed on Mover's Inventory Sheet
List of Damaged or MIssing Property
Receipt (yes or no)
Upload a File
please attach any photos of the damage
Should be Empty: