LOSS OR DAMAGES CLAIM FORM

LOSS OR DAMAGES CLAIM FORM
Privacy Act Statement

PRINCIPLE PURPOSE(S): The information requested is to be used in evaluating claims.

ROUTINE USE(S): The information requested is used in the settlement of claims for loss, damage or destruction of personal property and recovery from All Pro Movers & Storage, LLC.

DISCLOSURE: Voluntary; however, failure to supply to requested information and photos or to execute the form may delay ir otherwise hinder the payment of claim.
Instructions for filing a claim:

1) Fill out on-line claim form within 15 days of service.

2) Send an email to support@all-promovers.com with any additional information and details of loss or damage. Make sure to include photos of all damages in the email.

3) Allow the office 7-10 days for initial follow up call after submitting all pertinent information.

**All claims may take up to 60 days for a decision or settlement of claim and are subject to a $500 deductible as stated in your contract.

** No damage claims will be accepted on any accounts with an unpaid balance.
Move Date

MonthDayYear
Date
Customer's Name

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of protection chosen by customer:

Option A - StandardOption B - Declared ValueOption C - Full Value

List of Loss or Damaged Items

	Name of Item	Description of loss or damage	Purchase month/year	Amount of Purchase
1)
2)
3)
4)
5)