Untitled Document

EZ Moving & Storage Customer Service Claim Form : Household / Commerical

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Thank you for allowing EZ Moving & Storage to service your recent relocation. It is with our deep regret to find that you may have found that the handling of your shipment was less than satisfactory. For your convenience, we have provided this online version of our Claim Form to expedite the claim process. Please take a moment and complete the claim form that follows below and transmit it to us.

Please understand that while our best intentions is to process your claim quickly, we ask that you please allow approximately 30 to 45 days for the entire claim process to be completed.

Receipt of your claim will be acknowledged and a claim number along with one of our customer quality control representatives or an insurance adjustor will be assigned from our claims department. Your adjuster assigned will review the claim and contact you as needed, if necessary, with any further instructions.

Since all damaged items are subject to inspection, please do not proceed with any repairs, and do not dispose of any damaged items. A "Comments" section has been provided below should you need to provide further explanation for any items or issues referenced in your claim.

To aide us in the processing of your claim, please email us and provide as many digital photopgraphs you may have that depict the alledged damage(s). This will help us in processing your claim more efficiently.

If we can be of any further assistance, please click ------> Contact Us

Email photos to our customer service by clicking here ------> Photo Center NOTE: All photos must be .jpg format.

Please note that any damage claims submitted beyond 30 calendar days from the date of completion of the relocation cannot be honored. Not all claims or damage submitted and / or claimed can be honored pending circumstances investigated and / or as determined by our internal claim adjusters or external claim adjusters own investigation as required by applicable state and federal mandated laws.

Statement of Claim
Customer Information

To fill out this Statement of Claim form, you will need to reference your copy of the following items:

A. Household Goods Carrier's Bill of Lading and Freight Bill.
B. Household Goods Descriptive Inventory Sheet(s) (You should have this if additional coverage was purchased / insurance premium paid / deductible chosen for coverage over and above the free standard insurance offered)

In all cases, keep damaged articles (including shipping containers) for visual inspection. Arrangements will be made to inspect and estimate damage to the articles you have claimed.

Your name:
(or please provide the name of the EZ Moving customer, if different):

Your inventory number(s) of the item(s) being claimed#:
These numbers can be obtained from the left side of your Inventory Sheet(s) and / or a colored sticker tag that is on the piece(s). (Please place a comma between each inventory number you have

Home Phone Number:

() -

Business Phone Number- Extension:

() - ext -

Your Cell Phone Number:

() -

Your Fax Number:

() -

Your e-Mail Address:
To use our Internet Claim Form, you must enter a valid e-Mail address where you can receive information regarding your claim. This is where your receipt and progress status will be sent to keep you up to date on the claim. - Please be sure to double check your e-Mail and spelling after entering it into the box to the right

Moved To:
(Destination Address)

Address
City
State/Province		Zip/Postal Code

Moved From:
(Origin Address)

Address
City
State/Province		Zip/Postal Code

Present Address:
Enter your present address, city, state/province and zip/postal code. This address should be where you can be contacted for information about your claim.

Click if same as "Moved To:" address above.

Address
City
State/Province		Zip/Postal Code

The date your items were loaded onto the truck:

- - (mm/dd/yyyy)

The date your items were delivered:

- - (mm/dd/yyyy)

Have transportation / relocation charges been paid in full?
Indicate the appropriate circle if the charges for your move have or have not been paid.

Yes No

Did your employer pay the charges?
Also indicate if your employer paid the freight charges.

Yes No

If yes above, you are employed by:

Were there any packing services performed by our company? (i.e.having items packed into boxes by our company?)
Indicate if your shipment was packed by "you" the customer or by our company

By Customer By Company Both

If both for packing was selected above, please provide us with detailed information of your situation:

Was your shipment stored in a storage unit or warehouse?
Indicate if your shipment was or was not stored in a warehouse or storage unit at origin (where you moved from) or at destination (where you moved to).

Yes No

If 'YES', where?

Company Name
City
State/Province

What type of insurance valuation was chosen for your shipment when you moved?
Please check the declared value of your shipment and whether it was released at a value of 60 cents per pound per article (U.S. and Canada), or if you selected Declared Value Protection (U.S. only) or the Extra Care Protection or Customer Transit Protection plan (U.S. and Canada), and which version: no deductible, $250 deductible, $500 deductible. This information is located in the lower left portion of your Bill of Lading.

Select Insurance Chosen for Relocation:

$ .60 cents/lb. per article (U.S. and Canada)
Declared Value Protection (U.S./ Canada)
Full Replacement Protection - $0 deductible
(w/paid premium)
Full Replacement Protection - $250 deductible
(w/paid premium)
Full Replacement Protection - $500 deductible
(w/paid premium)
Amount of Coverage: $ .00

Comments or Additional Information you wish to provide: