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RELEASE OF CLAIM MOVING COMPANY
For the consideration, hereinafter stated, you, the undersigned hereby release Hercules Van Lines, its agents, and their insurers from any and all claim(s) for the loss of, or damage to any and all property received from you, the undersigned, for moving, storage, transportation or both.
The form of consideration for this Release of Claims is checked below:
__________ 1. The repair or replacement of all or part of your, the undersigned’s, goods that were lost or damaged.
__________ 2. The payment to you, the undersigned, the sum of $ _______________ in addition to the repairs or replacements of your, the undersigned’s, goods that were lost or damaged.
__________ 3. The payment to you, the undersigned, the sum of $ _______________ in FULL Settlement for the loss or damage of your, the undersigned’s, goods.
________________________ ___________________________________
Date Release Signed Claimant’s Signature
The undersigned
___________________________________
Witnesses Signature
PLEASE NOTE: YOUR SIGNATURE ABOVE ACKNOWLEDGES THE FINAL SETTLEMENT OF ANY AND ALL CLAIMS YOU MAY HAVE AGAINST THE MOVING COMPANY AND ANY AND ALL FURTHER CLAIMS ARE HEREBY WAIVED.
