Azalea Moving

Household & Corporate Claim Form

Thank you for allowing Azalea Moving to service your recent relocation. We regret if you found the handling of your shipment to be less than satisfactory.

For your convenience, we have provided an on-line Claim Form to expedite the claim process. Please complete the claim form that follows and transmit it to us.

You have ninety days from the date of final delivery to inspect your property and file a claim. We will handle your claim in an expeditious manner.

Receipt of your claim will be acknowledged and a claim number and an adjuster will be assigned. If you moved within the state of South Carolina, your claim will be processed by a customer service representative from Azalea Moving and by our insurance carrier. If you moved from one state to another, or internationally, your claim will be handled by a Claims Adjuster from Allied Van Lines. Either way, your adjuster will review the claim and contact you, if necessary, with any further instructions.

IMPORTANT NOTE

Since all damaged items are subject to inspection, please do not proceed with any repairs, and do not dispose of any damaged items. A "Comments" section has been provided at the end of the claim form should you need to provide further explanation for any items or issues referenced in your claim.

If we can be of any further assistance, please contact us at one of our toll free numbers.

Susan Cook
Manager, Customer Service
Azalea Moving & Storage, Inc.
1.800.849.8376 extension 13
1.843.767.4888 extension 13
Monday - Friday, 9am - 5pm (EST)
susan@azaleamoving.com

Statement of Claim
Customer Information

To fill out this Statement of Claim form, you will need to reference your copy of the following items:

a. Household Goods Carrier's Bill of Lading and Freight Bill.
b. Household Goods Descriptive Inventory.

In all cases, keep damaged articles (including shipping containers) for inspection. Arrangements will be made to inspect and estimate damage to the articles you have claimed.

Your name (and the name of the Allied customer, if different):

Your shipment's 5-digit (Canada) or 6-digit (U.S.)
Registration Number:

Home Phone:
(Area Code first)

Business Phone - Extension:
(Area Code first)

Your Fax Number:
(Area Code first)

Your Email Address:

Moved To:
(Destination Address)

Address

City

State/Province Zip/Postal Code

Moved From:
(Origin Address)

Address

City

State/Province Zip/Postal Code

Present Address:
Click if same as "Moved To:" address above.

Address

City

State/Province Zip/Postal Code

The date your items were loaded onto the truck: (mm/dd/yyyy)

The date your items were delivered: (mm/dd/yyyy)

Have transportation charges been paid in full? Yes No

Did your employer pay the charges? Yes No

Employed by:

Was your shipment stored in a warehouse? Yes No

If 'YES', where?

Agent Name

City

State/Province

What type of valuation was your shipment moved under?

Select One:

60 cents/lb. per article (U.S. and Canada)
Declared Value Protection (U.S. only)
Extra Care Protection/Customer Transit Protection - no deductible (U.S. and Canada)
Extra Care Protection - $250 deductible (U.S. only)
Extra Care Protection - $500 deductible (U.S. only)
Amount of Coverage: $