Information
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Customer Name
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Move Date
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Sales Order Number
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Customer's Phone Number
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Customer's Alternate Phone Number
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Customer's Email Address
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Customer's Current Address
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Address Where Damage Is Located
Damage(s) Description
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Damaged Item #1
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Make
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Model
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Store Purchased and Year
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Photo(s) of Damage (Take an overall picture of piece as well as a close up photo)
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Is there any other damages?
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Damaged Item #2
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Make
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Model
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Store Purchased and Year
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Photo(s) of Damage (Take an overall picture of piece as well as a close up photo)
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Is there any other damages?
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Damaged Item #3
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Make
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Model
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Store Purchased and Year
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Photo(s) of Damage (Take an overall picture of piece as well as a close up photo)
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Is there any other damages?
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Damaged Item #4
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Make
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Model
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Store Purchased and Year
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Photo(s) of Damage (Take an overall picture of piece as well as a close up photo)
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Is there any other damages?
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Damaged Item #5
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Make
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Model
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Store Purchased and Year
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Photo(s) of Damage (Take an overall picture of piece as well as a close up photo)
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Is there any other damages?
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Please email this form and then begin a new form
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Customer
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Two Men And A Truck Representative
