Customer Complaint Form
Customer Name
First
Last
Date Move
*
Name of Filing Person:
First
Last
Phone
Email address:
*
Second Email address:
Moving from address:
Destination address:
Type of Complaint:
Movers Complaint
Office Employee Complaint
Manager Complaint
Furniture damage Complaint
House damage Complaint
Other Complaint
Complaint details: Please provide as much infromation as possible
*
Valuation Prior to the Move was?
*
Released value .60 cents per pound. (this option 60 cents per pound per article, up to $75.00 per article.)
Full Replacement Value Protection
Purchased my own coverage
Who discovered damage?
When was damage discovered?
Please attache picture if availible:
SUBMIT
This field should be left blank
