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Claim Form
Customer Name :
Booking Id :
Phone :
Email :
Street :
Apt :
Invoice # :
City :
State/Province :
Moving to :
Moving from (city, town or prov.) :
Pickup date :
Delivery date :
Additional Comments about your claim :
Item # :
Article
Description of Damage or indicate if lost
Weight
Purchase Date
Purchase Price
Amount Claimed
Serial Code
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