Claims Form - Budd Van Lines

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number(Required)

Email Address(Required)

Move Number(Required)

Article Details

Inventory Number	Article	Shortage or Type of Damage	Date Purchased	Original Cost	Repair/Replacement cost	Actions

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IMPORTANT – READ

I am the owner of the property described. I did not cause or contribute to the damage set forth herein. All statements made in this statement of claim and any attached documents are true and correct to the best of my knowledge and belief, and constitute my complete and entire claim, no material information has been withheld.

IMPORTANT – READ

DOT regulations require that any claim for loss, damage or delay must be submitted in writing by Claimant and received by Carrier within the time limit set forth by the underlying contract with a maximum time limit allowed of 9 months from the date of delivery. The claim submission shall (1) include sufficient information to identify the shipment (2) make claim for payment of a specified or determinable amount of money and (3) be signed and dated by the owner of the property.

Signature(Required)

Once you press the submit button, your claim will be automatically sent to the BVL Claims Department. Please allow 48 business hours to be contacted by the department

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