Customer Complaint Form
Name of Filing Person:
Second Email address:
Moving from address:
Type of Complaint:
Office Employee Complaint
Furniture damage Complaint
House damage Complaint
Complaint details: Please provide as much infromation as possible
Valuation Prior to the Move was?
Released value .60 cents per pound. (this option 60 cents per pound per article, up to $75.00 per article.)
Full Replacement Value Protection
Purchased my own coverage
Who discovered damage?
When was damage discovered?
Please attache picture if availible:
This field should be left blank