"A Culture of Caring from Pre-hire to Retire"

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Personal Move Service Request Form

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

Affiliated Institution:
Status (i.e. new hire, retiree, alumni, student):
Name:
Spouse/Partner's Name:
Current Home Phone:
Cell Phone:
Current Email:
Approximate number of rooms of furnishing being moved:
Current residence address:
Street:
City:
State:
Zip:
New residence address:
Street:
City:
State:
Zip:
Anticipated relocation date:

I am interested in getting a Household Goods Move quote including the following services:

Packing Materials
Yes No

Need Packing Materials? Enjoy a 10% discount to the already competitive pricing,
plus fast, free shipping from our trusted supply partner Boxes A to Z Use coupon code HERS 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
vehicle Yes No

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

Laboratory Relocation Project Management - Business expense - please complete a Lab Relocation Project Management Service Request Form

*Non-deductible items. For more information about IRS move related tax compliance issues visit www.irs.gov/pub/irs-pdf/p521.pdf and review information provided on page 4 .