Fillable MOVING QUESTIONNAIRE / COMPLAINT *Please Print Your Responses (California)

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MOVING QUESTIONNAIRE / COMPLAINT *Please Print Your Responses (California)

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____________________________________________________________________________________
____________________________________________________________________________________
BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY • GAVIN NEWSOM, GOVERNOR
DEPARTMENT OF CONSUMER AFFAIRS • BUREAU OF HOUSEHOLD GOODS AND SERVICES
4244 South Market Court, Suite D, Sacramento, CA 95834
P (916) 999-2041 | F (916) 921-7279 | www.bhgs.dca.ca.gov
MOVING QUESTIONNAIRE / COMPLAINT
EMAIL: HHM.ENF@DCA.CA.GOV
*Please Print Your Responses Legibly
YO
UR INFORMATION:
Your Name: __________________________________________________________________________
Mailing address: ______________________________________________________________________
City: ___________________________________________ State: _________________ Zip: __________
Telephone: ____________________________ E-Mail address: _________________________________
Address you moved from:
Address you are moving to:
Date you first contacted the moving company: ____________
Date you booked your move: _________________ Date of your move: ___________________
BROKER INFORMATION: Check here if broker services were not utilized:
Name: _______________________________________________
Cal PUC T# _____________________ DOT #_______________________
Address: ___________________________________________________________________________
Telephone: ______________________________ Contact Person: _____________________________
How did you locate the broker?: Yellow Pages ( ) Internet ( ) Newspaper ( ) Other ( )
Additional information (e.g. name of directory, year & page number; URL; name of newspaper & date of ad)
MOVING COMPANY INFORMATION:
Name: _______________________________________________
Cal PUC T# _____________________ DOT #_______________________
Address: ___________________________________________________________________________
Telephone: ______________________________ Contact Person: _____________________________
How did you locate the moving company?: Yellow Pages ( ) Internet ( ) Newspaper ( ) Other ( )
Additional information (e.g. name of directory, year & page number; URL; name of newspaper & date of ad)
Movers Complaint Form (rev. 11/2019)
1. On your first contact with the mover, what was the rate quoted?
Were you given a price for cash vs. credit card? Yes ( ) No ( )
Were you charged more for paying with a credit card vs. paying with cash? Yes ( ) No ( )
Please explain________________________________________________________________________
2. Did a moving company representative offer to come to your residence to give you a written estimate based on
the visual inspection of your belongings prior to your move? Yes ( ) No ( )
If yes, what was the amount of the written estimate? _____________________________________
3. Were you provided with the following at least three days prior to the move?
Important Notice about Your Move document Yes ( ) No ( ) Date received: _________
Important Info. for Persons Moving Household Goods: Yes ( ) No ( ) Date received: _________
Agreement/Freight Bill (contract), stating the rate charged for the move and a “Not to Exceed”
price? Yes ( ) No ( ) Date received: _____________
4. Were you provided with a completed copy of the Agreement/Freight Bill (contract) at
the end of your move? Yes ( ) No ( ) Date receive it: ________________
5. Did the movers show up at the scheduled time? Yes ( ) No ( )
Scheduled arrival time _______________ Actual arrival time ____________________
If delayed, did the mover notify you of their delay? Yes ( ) No ( )
If yes, what was their explanation? _________________________________________________
6. Did a moving company representative explain prior to commencing the move that you have a choice
of valuation options? Yes ( ) No ( ) If yes, when _________________________________
Which option did you choose? Basic ( ) Actual Cash Value ( ) Full Cash (Replacement) Value ( )
7. If an estimate was given PRIOR to moving day, did a moving company representative perform a
walkthrough to review the items to be moved? Yes ( ) No ( )
Were you given a “Not to Exceed Price” agreeable to you BEFORE packing or loading your items? Yes ( ) No ( )
8. How many movers showed up to perform your move? ____________________________________________
9. Did the movers bring sufficient furniture pads, dollies, tools and a clean truck in good running condition?
Yes ( ) No ( ) If no, please explain _____________________________________________________________
10: Did the movers act in a knowledgeable and professional manner during the move? Yes ( ) No ( )
If no, please explain _________________________________________________________________
11: Did you ask for any additional service to be provided either prior to or after the move commenced?
Yes ( ) No ( )
If yes, what services did you ask for? _____________________________________________________
Prior to performing additional services, did a moving company representative ask you to sign a document
called a Change Order for Services, with a new “Not to Exceed” price? Yes ( ) No ( )
When was it given to you? ______________________________________________________________
12. How much did you pay for the move? ______________________________________
Movers Complaint Form (rev. 11/2019)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
___________________________________ ________________________________
What is the overcharge amount you are claiming? ____________________________
13. Did you request your household goods placed into storage as part of your move? Yes ( ) No ( )
If yes, for how long? _________________________________
14. Was there loss or damage to your household goods during your move? Yes ( ) No ( )
If yes, when did you notify the moving company, in writing, of the damages? _______________________
What is the total amount of loss and damages you are claiming? ________________________
Did the moving company acknowledge your written claim? Yes ( ) No ( )
When was your claim resolved? _______________________________________________
15. If you were dissatisfied with the move, did you pursue further action? Yes ( ) No ( )
With whom? Arbitration ( ) Small Claims ( ) Other Courts ( )
What was the disposition?
Comments (attach additional sheets if necessary) _________________________________________________
Please attach photocopies of all your moving documents (i.e. Agreement for Moving Services,
Shipping Order/Freight Bill, Important Notice About Your Move, Estimates, Change Order for Services,
letters and emails, completed claim forms, Inventory sheets, photographs of damages, etc.)
Shipper / Customer Signature Date
Movers Complaint Form (rev. 11/2019)
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MOVING QUESTIONNAIRE COMPLAINT *Please Print Your Responses (California)

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Completed 20 March 2021

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