Request for Arbitration Form

American Moving and Storage Association
Dispute Settlement Program

Request for Arbitration Form

The American Moving and Storage Association operates the Dispute Settlement Program pursuant to the guidelines provided at Section 14708 of Title 49, United State Code, under authority of the U.S. Department of Transportation.

Use this form to request arbitration if you have not been able to resolve your claim with your mover for articles in your shipment that were lost, damaged or destroyed during your move. Under the guidelines of the program, your request must be submitted in writing. Use this form to submit your request for arbitration and provide us with the information that we will need to process your request. Be sure to complete this form in its entirety.

PRINT OUT the completed form and fax or mail it to the address shown, along with any copies of additional material that will help us to better understand your request.

Personal Information

Your Name: Date:

Your Address:

City: State: Zip:

Telephone: Fax:

Email:

Information About Your Move

Name of Your Moving Company:

If your move was handled by an agent of a van line, what is the name of the van line?

City, State Moved From:
Date Shipment was Picked Up:

City, State Moved To:
Date Shipment was Delivered:

If Available, the Shipment or Bill of Lading Number:

Did the shipment move under your name? If not, whose name did the shipment move under?

What is the $ value of your claim:

Description of Disputed Claim for Loss or Damage

Describe below your LOSS AND DAMAGE CLAIM with your mover, including how you believe your claim should be resolved by your mover:

Describe below your mover's response to your claim:

How Much Does Arbitration Cost?

To maintain a fair and neutral position, our program is administered by the National Arbitration Forum. The NAF is one of the world's largest neutral administrators of arbitration and mediation services. The amount of the NAF per-case administrative fee is based on the amount of the claim that is in dispute. For claims up to $10,000 the fee is $400. For larger claims, the fee is $400 plus one (1%) percent of the amount over $10,000. Unless otherwise agreed to by both parties, you and your mover pay equal shares of the fee. Because many disputes are settled before arbitration, you do not need to pay the fee at this time. Also, documents supporting your position should not be sent at this time, but kept for use later if your case cannot be settled and proceeds to arbitration.

If you choose to put your request for arbitration in the form of a letter, be sure to include all of the information that we have asked for on this form and return the completed form to:

American Moving and Storage Association
Attention: Dispute Settlement Program, 1611 Duke Street, Alexandria VA 22314-3482
Or Fax Your Letter to: (703) 683-7524

PRINT OUT the completed form and fax or mail it to the address shown, along with any copies of additional material that will help us to better understand your request.

Your Name:			Date:
Your Address:
City:	State:		Zip:
Telephone:		Fax:
Email:

Name of Your Moving Company:
If your move was handled by an agent of a van line, what is the name of the van line?
City, State Moved From:	Date Shipment was Picked Up:
City, State Moved To:	Date Shipment was Delivered:
If Available, the Shipment or Bill of Lading Number:
Did the shipment move under your name? If not, whose name did the shipment move under?
What is the $ value of your claim:

American Moving and Storage Association Dispute Settlement Program