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What type of Damage occurred? Check all that apply:
Premises Dwelling or Structure
Where did the Damage Occur? Check all that apply:
When was the Damage discovered?
Who discovered the Damage?
Basic Coverage (All Local, Intrastate, and Storage Moves):
$.60/Lbs/Article with a $500 Deductible
Basic Coverage (Interstate Moves Only):
Claimed Amount ($):
*If the damage is to premises (walls, floors, etc.), write a brief description of the damage above. Attach any receipts, proof of value, appraisals, repairman's estimates, if they are available. DO NOT CONTRACT, PAY FOR OR OTHERWISE OBLIGATE SOUTHSIDE MOVING AND STORAGE OR MID-ATLANTIC MOVING & STORAGE FOR ESTIMATES OF REPAIRS WITHOUT PRIOR WRITTEN APPROVAL. SOUTHSIDE MOVING AND STORAGE OR MID-ATLANTIC MOVING & STORAGE IS NOT LIABLE FOR ANY OBLIGATIONS WHICH ARE INCURRED BY YOU. By submission of this form the undersigned hereby makes a solemn oath to the truth of the statements contained herein, and to all that is attached hereto.
Thank you for submitting your claim form. A representative from our claims department will contact you shortly to review the claims process. If you have any questions regarding the status of your claim; please email firstname.lastname@example.org.