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Claim Form

Claim form

  • Customer Information
  • Where did you move to? 
  • Where did you move from? 
  • If "yes", please provide present address below.
  • Present Address
  • Additional Information
  • if 'yes' then where?

  • Please enter the information regarding the item you wish to claim. To be processed correctly, the claimed item must include an Inventory Item number OR if your claim resulted from a local or Intra-state move, there may not be any inventory number associated with your claim. NOTE: If the item is repairable but you will accept a nominal cash allowance instead of repairs, enter the amount you are requesting. If repairs are preferred, click the "repair" box. Arrangements may be made to inspect the claimed item. However, please enter a dollar amount claimed and/or click the repair box for every item claimed.

  • Claim #1
  • Claim #2 (If Applicable)
  • Claim #3 (If Applicable)

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