Institution:
School/Department:
Department Contact:
Phone:
Email:
New Hire's Name:
Spouse/Partner's Name:
New Position:
Start date:
Current Home Phone:
Cell Phone:
Current Email:
Current street address:
Destination - city/state (and street address if known):
Anticipated relocation date:
Standard School/department policy applies: Please check only one below:
Standard School/department policy applies (must be on file with HERS)
Relocation allowance of $

Household Move including: Standard international shipping services include packing materials; full pack and unpack service; door to door transportation and standard customs clearance. Additional charges such as storage duties, taxes, demurrage, per diem, additional port charges or customs examination fees may apply and will be brought to your attention if required.

Approximate number of rooms of furnishings moving:
Additional Services requested/required:

Crating/Uncrating Service
Yes No

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

Appliance/Fixture Servicing/disconnect reconnect/adaption
Yes No

Auto Transportation
Yes No
vehicle year/make/model

Conversion costs if applicable (vehicles must be in compliance with US EPA)
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*

>!-- Post hire Area Familiariztion Tour *
Half day custom tailored tour Full day tour

Cross Cultural Training up to: days or $*

Language Training up to: days or $*

Temporary Housing up to days or $*

Spouse/Partner Career Counseling *
Yes No up to:$

Rental Assistance (schedule and accompany employee on viewing appointments; advise local norms and provide lease negotiation assistance)*
Yes No up to:
Pet Transportation:
Yes No

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

Laboratory Relocation Project Management – Business expense
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/publications/p521/ar02.html#d0e1353