Cal-Safe Movers Claim Form
Claim Number Auto Populates. Any fields with with red * Asterisk are required.
Your Claim Number
*
Bill of Lading Number
*
Shipper Name
*
Date of Move
*
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Month
-
Day
Year
Date of your move
Today's Date
*
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Month
-
Day
Year
Cal-Safe Agent Name
Crew Member Names
Customer Information
Please provide the contact information that was used to schedule your move.
Your Name
*
Your Email
*
Date of Move
*
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Month
-
Day
Year
New Address (Address of Relocation)
*
Nature of Claim
*
Please Select
Damaged
Missing Items
Billing
Crew Issues
Management Issues
Timeliness
Communication
Other
If *other, please explain
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Continue To Item List
Item / Article List
Please provide a complete list of the items or articles being referenced in the claim.
Please Check The Most Appropriate Option for Damage Type
*
Damage (Furniture)
Damage (Box Contents)
Damage (Home)
Missing Items
Other
If Box contents are damaged, did you or Cal-Safe pack the contents of the boxes?
*
Self-Packed
Cal-Safe Packed
Neither
Did the item come out of your storage or was it loaded/unloaded in a 3rd part truck/container/PODSS?
*
Yes
No
Other
Is the Article or any of the Articles, particle board or pressboard
*
Yes
No
Other
Did Cal-Safe Movers disassemble and reassemble?
*
Yes
No
N/A
Did you notify the movers of this damage on move day?
*
Yes
No
N/A
Additional Details
Inventory List
Choose Valuation (choose one)
*
- Basic (60 cents/lb./article)
- Full Value Protection-$250 Deductible
- Full Value Protection-$0 Deductible
- Full Value Protection-$500 Deductible
Other
Total Move Cost
*
Requested Total Dollar Value of Claim
Please provide us with the total requested dollar value of the items listed on the claim.
Upload Supporting Documents (Images of damaged items, receipts, etc)
Browse Files
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Choose a file
Please provide as much supporting documentation as possible including photographs of damaged items, description of damages and receipts. In the event no receipts are available the burden will be upon the owner of the items to provide proof of value. Cal-Safe Movers reserves the right to make a final determination with regards to value.
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of
Additional Information
Please provide any additional information that is relevant to the claim. Upon agreement and submission of this form, our team will review the information provide and contact you with any questions and/or resolutions.
Additional Claim Details and Specifics.
Please provide any additional information that is relevant to the claim.
Signature
*
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