File a Claim – Moved Between States

Dependable Relocation Services, Inc. – INTERSTATE CLAIM FORM

Corporate Headquarters 450 Airline Drive, Suite 100, Coppell, TX 75019 888-461-3737 Agent for United Van Lines, LLC, U.S. DOT No. 077949

  • MM slash DD slash YYYY

  • MM slash DD slash YYYY

  • Inventory NumberArticle WeightArticle DescriptionDescription of loss/damageDate of purchase/Age of itemCost to replaceAmount ClaimedCarton Damaged (Y/N) if applicable 

  • 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 brief and constitute my complete and entire claim. No material information has been withheld. U.S. DOT regulations require that any claim for loss, damage or delay must be submitted in writing by claimant and received by career within 9 Months from date of delivery.
  • Typing your name below will serve as an electronic signature