Portland Movers, Blue Bird Transfer, A Portland Moving Company
 
2500 E. Fifth Street         
Vancouver, WA 98661        
Blue Bird, Excellence in Moving

Statement of Claims for Lost or Damaged Goods

Bill of Lading Number Date of Filing Claim:
Name Email Address
Address Home Phone
City Work Phone
State & Zip Code &

Regardless of any previous comments, letters or notations, you must include all articles on this form in order to receive claim compensation.  You may wish to print a copy of this page for your records before submitting it to our office.

Inventory Item# Article Describe Nature of Loss
or Damage		 Estimated Weight Date Acquired Original Cost Amount Claimed
1.
2.
3.
4.
5.
6.
7.
8.
9.

All entries made in this Statement of Claim are true and correct to the best of my knowledge and belief, and constitute my complete and entire claim. No material fact has been withheld which should be included in this claim for
Amount: 

Comments:
    

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