Referral Program











BBB and AMSA

PRESENTATION OF LOSS OR DAMAGE

 
Name:
Job #:
Current Address
Email:
Telephone #:
Work #:
Date of pick-up
 Date of delivery:
Total value of your goods
Storage:
In
Out
Coverage: Basic valuation ($0.60
per pound)		 Additional protection
Were the goods packed / unpacked by our moving company? Yes No
Was there any external damage done to the packing container? Yes No
The damage was discovered: By:

List all damaged items below

Inventory #

  

Description of
item damaged

Age of
item

Estimated
weight

  

Estimated
cost of repair

Estimated cost
of replacement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



Additional Comments:



Please note: No claim settlement will be made until all shipment bills have been paid. Repair estimates or any other form of documentation can be attached to this report in order to speed settlement. The insurance company may wish to inspect damage. Damage that can’t be verified will be acknowledged upon direct request from the insurance company.


I hereby certify the above information is true and accurate to the best of my knowledge and belief.


Name: Date: / /