viagra online without prescription buy vicodin percocet online buy adderall online

Claim

Please enter 1 item per page. When finish with page enter submit at bottom of page. Then start over on page with new item.

Your Name (required)

Customer Number (required)*

Date of Move

Date Claim Filed

Point of Origin

Point of Destination

Your Email (required)

Contact Phone Number

Name of Damaged Item

Describe Damaged Item

Date of Purchase

Cost of item new

Amount Claimed

Proof of cost (receipt, etc)

Weight of Item in lbs

Cost to repair or replace

Amount you would accept for payment in full for item

Did you pay extra for inventory

Was item packed by movers

Was item unpacked by movers

Did you pay for additional coverage

Do you understand that if no additional money was paid for coverage the maximum coverage would be base on the .60 cents per pound per article.

Your Message

 

 

 

viagra online without prescription buy vicodin percocet online buy adderall online