Interstate Moving Claim Form

Please fill out the form below and a representative will contact you as soon as possible! To speak to a representative immediately, call 1-800-441-7311 or send an email to us to request information. Please enable cookies for your browser to be able to use this form.

(Items BOLD are Required)


Name (First Last):
E-mail Address:
Origin Address:
Origin City:
Origin State:
Origin Zip code:
Destination Address:
Destination City:
Destination State:
Destination Zip:
Phone Number w/ Area Code:
Registration number:
Load Date:
Storage Agent:
Declared Value:
Employer (if employer paid for move):

Call 1-866-727-0506

Name:

E-mail:

Move Date:

Moving To ZIP:

Moving From ZIP:

International Moving