HOUSEHOLD GOODS SHIPMENT SERVICE EVALUATION

This information is used to: 1) substantiate payment to the carrier, 2) develop semiannual quality reviews, and to determine actual carrier selection
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 filed: Yes No
Excellent Good Fair Poor
TOTAL OVERALL EVALUATION:
If you move again, would you use this carrier? Yes No
Comments:
Submitted Date: