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Please complete this form and “submit” it electronically below. If you have any questions, please don't hesitate to contact a a HERS team member

Account Service Request Form

Institution:
School/Department:
Authorized Hiring Contact:
Phone:
Email:
New Hire Name:
Spouse/Partner's Name:
New Position:
Current Home Phone:
Cell Phone:
Current Email:
Current residence address:

Street:
City:
State:
Zip:
Comments:
Destination address:
Street:
City:
State:
Zip:
Comments:
Anticipated relocation date:
Standard School/department policy applies: Yes No
Or total dollar limit budget to new hire:

All relocation services checked below, as employee needs or chooses. If a dollar limit applies, please indicate up to a $ allowance.

Post hire Area Familiarization Tour and/or Rental Assistance*
Half day custom tailored tour ~ $500 Full day tour ~ $1000

Temporary Housing up to days or $*

Spouse/Partner Career Counseling *
Yes No

Rental Assistance *
Yes No

Household Move including:
Packing Materials
Yes No

Packing Material delivery to residence
Yes No

Extra stops
Yes No

Full Packing Service
Yes No

Packing of fragile only
Yes No

Full Unpacking Service
Yes No

Unpacking of Mattresses only
Yes No

Packing material debris pick-up (included in unpacking service)
Yes No

Crating/Uncrating Service
Yes No

Extra Stops at other than Primary residence
Yes No
(# authorized)

Appliance/Fixture Servicing/disconnect reconnect
Yes No

Auto Transportation up to
Yes No
vehicle

Bulky items:
Pianos: Yes No
Riding Mowers: Yes No
Big Screen TVs: Yes No
Boats/Canoes: Yes No

Storage up to 30 days *
Yes No
Storage beyond 30 days
Yes No up to days*

Pet Transportation:
Yes No

Settling In Services (assistance with completion of local registration or legal documentation paperwork; residence preparedness extras i.e. maid service, window treatment installation, etc.) *
Yes No

Laboratory Relocation Project Management - please complete a Lab Relocation Project Management Service Request Form Yes No

*Taxable benefits which must be reported as additional income to your employee if paid for or reimbursed by your institution. For more information about Tax compliance issues visit www.irs.gov/pub/irs-pdf/p521.pdf.