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Claim Form
Contractual Liability – Compensation

 

 How to use this form:

Step 1: Fill out your personal information. Your ref no’ will be stated on the quote you received from us (check your emails).

Step 2: Fill out your claim information. List the damaged items. Include the following information: name of item (bed, dresser, table, chair, etc’), damage description (short description of the damage, scratched, broken, missing, etc’) and estimated weight (LBS) – use manufacture’s documentation. For each item, please mention the supporting documents you have attached (pictures, receipts, etc’).

Step 3: Attached supporting documents. You may attach pictures of the damaged item and receipt (proof of ownership).

Step 4: Submit the form and Email us any necessary  supporting document to
claims@GreenWheelsMoving.com

 
How do we process your claim?

Upon receipt of your email, our claim department will review your claim. Our claim specialists will confirm the damage, weight and the supporting documents.


Contractual Liability – Compensation:

Based on our contractual liability, compensation in the event of damage is 60 cents per LBS per article up to a maximum of $50 per article (please refer to the quote, contract, bill of lading and addendum to bill of lading).


How do we pay your claim?

 All approved claims will be paid within 30 business days. A check will be mailed to your mailing address as shown here.

 
 
 

contact info


 

 

 

 
     
 

 

 

 

Ref No' GW -
Contact Name:
Email:
Mailing Address:
Home Phone:
Mobile Phone:
Company Name:
Work Phone:
Move Date:
 
 
 

 

moving from?
 

 

 

 
     
 

 

 

 

Address:
Address(2):
City:
State:
Zip: Zipcode lookup
 
 
 

 

moving to?

 

 
     
 

 

Address:
Address(2):
City:
State:
Zip: Zipcode lookup
 
 
 
 

Claim Information:

Please specify in details the damaged items based on the table below. Your valuation / compensation are based on $0.60 per LBS up to a maximum of $50 per item (please refer to the following documents: Bill of Lading / Shipping Documents, Terms & Conditions / Order for Service). Please attach supporting documents (pictures, receipts, etc’).

 

 

 

 
     
 

 

 

 

 

 

No’

Item

Damage Description

Estimated
Weight (LBS)

Supporting documents
attached

1

 

 

 

 

2

 

 

 

 

3

 

 

 

 

4

 

 

 

 

5

 

 

 

 

6

 

 

 

 

7

 

 

 

 

8

 

 

 

 

9

 

 

 

 

10

 

 

 

 

   
Comments / Additional Information
 
 

 
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