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Transfer

& Storage

Claim Form

Fill out the form below to submit your claim.

As a condition precedent to recovery, claim(s) must be in writing and supported by a paid invoice. Boer's must be notified of a property claim with one (1) day from the date of delivery of property. Boer's must be notified of a cargo claim within two (2) days from the date of delivery of property. Boer's must be notified of packing claims (coverage only applies to Carrier Packed Cartons) within ten (10) days from the date of delivery of property.

First name

Last name

Email

Phone

Today's Date

Month

Day

Year

Date Shipment Loaded

Month

Day

Year

Origin Address

City

State

Zip code

Destination Address

City

State

Zip code

Type of move

Description of items, nature & extent of loss/damage.

Dollar value at time of loss

Dollar amount now claimed

Proof

Please provide photo proof of damage

Description of items, nature & extent of loss/damage.

Value at time of loss

Amount now claimed

Proof

Please provide photo proof of damage

Description of items, nature & extent of loss/damage.

Value at time of loss

Amount now claimed

Proof

Please provide photo proof of damage

Description of items, nature & extent of loss/damage.

Value at time of loss

Amount now claimed

Proof

Please provide photo proof of damage

Description of items, nature & extent of loss/damage.

Value at time of loss

Amount now claimed

Proof

Please provide photo proof of damage

Description of items, nature & extent of loss/damage.

Value at time of loss

Amount now claimed

Proof

Please provide photo proof of damage

Signature

Signature field is empty.

The undersigned, signer of the foregoing statement, hereby makes solemn oath to the truth of the statements contained herein, and exhibits attached hereto.

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