File a Claim "*" indicates required fields Customer InformationName on Bill of Lading/Contract* Phone Number*Alternate Phone NumberEmail* Current Address* City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP Code* Information About Your MoveOrder Number* Type of Move*Intrastate (Local)Intrastate (Long Distance)Interstate (Long Distance)Origin Address* Pickup Date* MM slash DD slash YYYY Destination Address* Delivery Date* MM slash DD slash YYYY Were you household goods placed in storage?* Yes No If so, where and now long?* Valuation Coverage1. Was the shipment released at carrier's basic valuation at $0.60 per pound per article?* Yes No, I used 3rd party insurance 1 a. Please state the 3rd party insurance provider* Items Damaged or LostItemInventory #Description of Damage Lost or Damaged?LostDamagedWho packed this item?Carrier PackedPacked by OwnerPurchase Date MM slash DD slash YYYY Item Weight Item Value (US dollar) Add item by clicking the + button below Upload Photos of Damaged Items Drop files here or Select files Accepted file types: jpg, jpeg, gif, png, webp, Max. file size: 4 MB, Max. files: 20. Additional Information/Description Regarding ClaimI am the owner of the property described. I did not cause or contribute to the damage set forth herein. All statements made in the statement of claim and any attached documents are true and correct to the best of my knowledge and belief, and constitute my complete and entire claim. No material information has been withheld. Element Moving reserves the right to require notarized statement or affidavit:Signature of Claimant*Printed Name* Date* MM slash DD slash YYYY *A notification of receipt will be sent to the email address you provided in your claim. Please check all possible folders/tabs (including spam) should you not find it within your general inbox. If you have any questions, please give us a call. Δ
