Initial Damage & Loss Form

Initial Damage & Loss Form
IMPORTANT INFORMATION: This is not a claim form. This form is used to submit a request to file a claim with Wirks Moving & Storage. Completing this form does not constitute a properly presented claim under Uniform Bill of Lading Section (2B). A properly presented claim will require you to provide an estimated replacement value and description of damage or loss.

Wirks Moving & Storage will issue a claim number and send a claim form via email to the email address on file upon receipt of this document.

PLEASE COMPLETE THE FOLLOWING INFORMATION:
Date Of Move*

MonthDayYear
Shipper's Name*
Shipper's Phone*
Shipper's Email*
Damage To (Check all that apply)*

INTERIOR/EXTERIOR OF ORIGININTERIOR/EXTERIOR OF DESTINATIONHOUSEHOLD GOODS (PACKED BY OWNER)HOUSEHOLD GOODS (PACKED BY CARRIER)
Detailed Statement Of Reported Damages*
Household Goods Reported Missing From Shipment
Shipper's Comments*
Upload Supporting Documents

Cancelof
Signature Of Shipper*

Clear
Should be Empty: