Arbitration Request Form
Arbitration Request Form
Date
First Name
*
Last Name
*
Current Mailing Address
*
City
State
Zip Code
Telephone Number
*
Email Address
*
Name of Moving Company
*
Moving Company DOT Number
*
Moving Company Address
*
If Mover is an Agent for a Van Line, Which One?
What type of Dispute are you seeking to arbitrate:
*
Loss or Damage
Disputed Charges
Both
What is the Exact Dollar Amount in Dispute?
*
Did the Mover Offer a Settlement?
*
Yes
No
If Yes, how much?
*
City and State You Moved From
City and State You Moved To
Date your shipment was Picked Up
*
Date your shipment was Delivered
*
Shipment or Bill of Lading Number
Did the Shipment move under your name?
*
Yes
No
If no, which name did the shipment move under?
Description of Dispute
Please provide a brief description of the dispute with your moving company, including how you believe your claim could be resolved by your mover. If your dispute is accepted into arbitration, you will have an opportunity to provide further detail and supporting materials such as photos to the neutral third-party arbiter.
*
Submit
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