Online claim for Property Damage

For your convenience, and to better expedite the claim process, you may submit your claim online. Please complete all of the required fields.

Customer Information
Customer Name *
Customer Name
Customer Phone
Customer Phone
Current Address
Current Address
Current Address
Damaged Property
Address of Property That is Damaged
Address of Property That is Damaged
Details
Date Damage Occured
Date Damage Occured
Date Damage Reported
Date Damage Reported
Did employer pay for move? *
Area/Item #1
Area/Item #2
Area/Item #3
Complete & Submit
I am the owner of the property described. I did not cause or contribute to the damage set forth herein. All statements made in this 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. DOT regulations require that any claim for loss, damage or delay must be submitted in writing by claimant and received by carrier within 30 days from date of delivery. See general instructions below this form for additional information.