Johnson Storage & Moving Co. Online Claim

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First Name: * Last Name: *

Address: * Apt/Suite#:

City: * State: * Zipcode: * -

Phone Number: * () - Work Phone Number: () -

Email address: *

Name of Employer:

Order # / Bill of Lading #:*

Pickup Date: (mm/dd/yyyy)* / /

Delivery Date: (mm/dd/yyyy)* / /

Origin Address:*

Delivery Address:*

Was shipment in a warehouse?* Yes No

Are you the owner of the goods in question? * Yes No

Have all transportation/storage charges been paid?* Yes No

Customer Signature:*

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Request moving and storage information from us.

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Moving From City/State:

Moving To City/State:

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Information/Other please provide request in box below:

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Email address: *

Phone:

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