"A Culture of Caring from Pre-hire to Retire"
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 Yes No Vehicle Make, Model and Year 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 .
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 Yes No Vehicle Make, Model and Year 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