Household Goods Shipment Service Evaluation

National Acct:
Employee Name:
Booking Agent:
Pickup Date:
Delivery Date:

Van Line:
Origin Agent:
Destination Agent:

Origin:
Destination:
Bill of Lading #

ORIGIN SERVICES:

Was premove survey made?: Yes No
If Yes: By Phone In Person

Was Pick up made on date promised? Yes No
If No, No. of Days Late:

	Excellent	Good	Fair	Poor
Packing Service:
Loading Service:
Appliance Servicing:
Appearance of Moving Personnel:
Courtesy of moving Personnel:
Overall Origin Services Evaluation:

STORAGE:
Was shipment placed in storage? Yes No

DESTINATION SERVICES:

Was delivery made within the dates promised? Yes No
If No, No. of Days Late:

Were you advised of changes in delivery date? Yes No

	Excellent	Good	Fair	Poor
Unloading/Unpacking Service:
Appliance Servicing:
Appearance of Moving Personnel:
Courtesy of Moving Personnel:
Condition of Property on Delivery:
Overall Destination Services Evaluation:

VEHICLE SERVICES:

Was pickup made on date promised? Yes No
If No, No. of Days Late:

Was delivery made within the dates promised? Yes No

Number of days from Pickup to Delivery?	Vehicle 1		Vehicle 2
	Excellent	Good	Fair	Poor
Overall Vehicle Services Evaluation:

CLAIM:
Was a claim filled: Yes No
	Excellent	Good	Fair	Poor
TOTAL OVERALL EVALUATION:

If you move again, would you use this carrier? Yes No

Comments:

Submitted Date:

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