Worry Free Moving LLC - High-Value Inventory Form Worry Free Moving LLC High-Value Inventory Form Important: Federal law requires items valued at more than $100 per pound to be listed separately. Failure to complete this form may limit liability coverage for high-value items. Customer Information Name: Moving Date: Origin Address: Destination Address: Phone: Email: Selected Valuation Option Basic Coverage (Released Value): $0.60 per pound per article Full Value Protection Instructions Complete this form PRIOR to your move List ALL items valued at more than $100 per pound Provide detailed descriptions, including make/model/serial numbers when applicable Attach photos or appraisals when available Return completed form to Worry Free Moving LLC BEFORE your move date High-Value Items Inventory Item Description Age Original Purchase Price Current Value Serial/Model Number Room Location Special Handling Instructions + Add More Items Common High-Value Items to Consider Artwork and antiques Crystal and fine china Designer furniture Electronics over $500 Musical instruments Collectibles Rare books Custom-made items Jewelry and watches* Fine rugs Wine collections *Note: We recommend personally transporting jewelry, watches, and other extremely valuable small items. Declaration I declare that the values stated above are correct to the best of my knowledge and belief and that I have revealed the presence of all items valued at more than $100 per pound. I understand that my failure to list an item may limit Worry Free Moving LLC's liability for loss or damage. Customer Signature Date Worry Free Moving LLC Representative Date SUBMIT THIS FORM BEFORE YOUR MOVE DATE Worry Free Moving LLC 11715 Mahoning Avenue, SUITE D North Jackson, OH 44451 Phone: 330.435.8686 Email: service@worryfreemovers.com For office use only: Received by: _________________ Date received: _________________ Processed by: _________________ Print Form Email Form Reset Form
