North Carolina Mover - All American Relocation, Inc.

Claim Form

First Name : *

Last Name : *

Address: *

Apt/Suite#:

City: *

State: *

Zipcode: * -

Email: *

Phone Number: ( ) - *

Work Phone: ( ) -

Name of Employer:

Order / Bill of Lading : *

Pickup Date: / / *

Delivery Date: / / *

Origin Address: *

Delivery Address: *

Inventory #	Article Name	Description of Damage	Purchase Date	Purchase Price	Claim Amount
				$	$
				$	$
				$	$
				$	$
				$	$
				$	$
				$	$

A hard copy of this Claim form will be sent to you for your signature.
Please promptly return to our Claims department for immediate processing.

Customer Signature:

Call Us Anytime For A Free Estimate at 1.800.366.8809

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Copyright 2002, All American Relocation, Inc.
All American is an Agent for Mayflower Transit
I.C.C. No. MC-2934 • USDOT#125563
NCUC C-1590

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