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Claim Request Form
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256-858-6683
Use the form below to start your claims process.
Have a question? Give us a call at
(256) 858-6683
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Full Name
First
Email
We'll send you an email with instructions on how to submit photos of your damages
Phone
How many items are in your claim?
(Required)
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Claim Item 1
(Required)
Item 1 Name
Describe Nature of Damaged Item
Item Age (Est Years)
Original Cost
Current Value
Amount Claimed
Claim Item 2
(Required)
Item 2 Name
Describe Nature of Damaged Item
Item Age (Est Years)
Original Cost
Current Value
Amount Claimed
Claim Item 3
(Required)
Item 3 Name
Describe Nature of Damaged Item
Item Age (Est Years)
Original Cost
Current Value
Amount Claimed
Claim Item 4
(Required)
Item 4 Name
Describe Nature of Damaged Item
Item Age (Est Years)
Original Cost
Current Value
Amount Claimed
Claim Item 5
(Required)
Item 5 Name
Describe Nature of Damaged Item
Item Age (Est Years)
Original Cost
Current Value
Amount Claimed
Claim Item 6
(Required)
Item 6 Name
Describe Nature of Damaged Item
Item Age (Est Years)
Original Cost
Current Value
Amount Claimed
Claim Item 7
(Required)
Item 7 Name
Describe Nature of Damaged Item
Item Age (Est Years)
Original Cost
Current Value
Amount Claimed
Claim Item 8
(Required)
Item 8 Name
Describe Nature of Damaged Item
Item Age (Est Years)
Original Cost
Current Value
Amount Claimed
Item 9 Name
Describe Nature of Damaged Item
Item Age (Est Years)
Original Cost
Current Value
Amount Claimed
Item 10 Name
Describe Nature of Damaged Item
Item Age (Est Years)
Original Cost
Current Value
Amount Claimed
Acknowledgement of Terms
(Required)
1. Claimant does hereby swear or affirm that all entries made in this Motivated Movers Claims Form and contained in any supporting documentation are true and correct to the best of my knowledge and belief, and constitute my complete and entire claim growing out of or in any way connected with the transportation or storage of my possessions.
2. The claimant does further swear or affirm that there have been no material facts relative to this claim that have either been withheld or misrepresented.
3. Motivated Movers reserves the right to inspect damaged items within a reasonable time. Do not proceed with repairs, replacement, or discarding of damaged items until Motivated Movers has had the opportunity to examine the completed Motivated Movers Claim and determine the course of action to follow.
4. If you are claiming any cartons, which were packed by Motivated Movers, please indicate whether or not the carton was damaged. Please also save the packing material and carton for our inspection.
5. Motivated Movers liability shall not exceed the cost of repairing or replacing the property lost or damaged with materials of like kind and quality not exceeding the actual cash value of the property at time and place of loss, with due allowance for depreciation and deterioration howsoever caused.
6. For any items requiring repair, a repair estimate must be furnished prior to a claim amount being settled upon.
7. Copies of original purchase receipts should be submitted with your claim for items requiring replacement.
8. Please provide the manufacturer’s name, the model, and serial number of any appliances or electronics equipment claimed as missing or damaged.
9. Pictures of damages should be submitted along with claims form. Pictures should be easily identifiable as to what article is being shown and the damages therein.
10. In making a claim, you must be prepared to justify the value you have placed on the lost or damaged articles
11. You may be required to submit documents supporting your claim including a paid invoice.
12. Claimant, who is the owner of all items claimed to be lost or damaged, must agree to the terms at the end of the form.
12. I certify that the information that I have submitted is true and accurate to the best of my knowledge. Any misrepresentation or false submission of information may result in denial of claim.
13. Failure to comply with these terms may result in reduced settlement and/or denial of claim.
By clicking “I Agree” , you acknowledge that you have read, understood, and agreed to be bound by the Acknowledgement of Terms above.
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