COUSINS USA

REPORT DAMAGE AND LOSS

*Order No. :

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*Claimant's Name:

Company Name:

*Phone:

*Email:

*Date of Claim:

Were your goods packed and unpacked by the moving company ?

Was there any external damage to the packing containers ?

When was the damage discovered ?

By Whom ?

	Article Description	Describe Damage M=missing, D=damanged	Age of Item	Cost New	Current Value

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Move Size:

From (zip):

To (zip):

Name:

Email:

Telephone:

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