Move Date and Time*

First/Last Name *
The name of the contractual customer

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]