TOP NOTCH PRO MOVERS – CLAIM FORM 15311 Farm Creek Dr, Woodbridge, VA 22191 Phone: (703) 343-9603 | Email: ___________________________ NOTICE TO CUSTOMER: Please complete and return this form within 30 days of delivery if you wish to file a claim for damaged or lost items. All claims must be submitted in writing and include as much supporting documentation as possible (photos, receipts, etc.). Claims will be a nowledged within 30 days and resolved within 120 days per Virginia law. Full Name: ________________________________________________________________________________ Phone Number: ________________________________________________________________________________ Email Address: ________________________________________________________________________________ Move Date: ________________________________________________________________________________ Origin Address: ________________________________________________________________________________ Destination Address: ________________________________________________________________________________ # Item Description Nature of Damage / Loss Estimated Value Photos Attached? (Y/N) 1 2 3 4 5 6 7 8 9 10 Customer Signature: ___________________________ Date: ____________________ ATTACHMENTS CHECKLIST n Photos of damage n Copy of the Bill of Lading n Copy of the Estimate or Invoice