Move Date and Time *

First/Last Name *
The name of the contractual customer

Email Address *
Email we can reply to about this claim

Move Number *
Move # can be found on your the contract you signed to confirm move details

Did you hire Moving Proz LLC for packing services? *
Did you pack the boxes or did we?
YesNoOther

Where did the damage occur? *
OriginOn The TruckDestinationOther

Damaged Item *
ex. Dresser, kitchen table, Grandfather Clock etc.

Manufacturer/ Brand/ Model Number(s) *

Explanation of Damage(s) *

Composition *
What was the Item made of?
MetalWoodParticle BoardGlassMarbleOther

Is the item repairable? *
What was the Item made of?
YesNoMaybe

Explanation of incident *
Be as specific as possible (names, suggestions, warnings, accidental/intentional, negligence, reactions)

Were you present during the incident and if not where where you when it happened? *

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If you need to send more photos, please send them to [email protected]