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Moving Request Form

To schedule a physical survey of your home and/or to receiveestimates, or more information, please complete the following form. The information will be sent electronically to all Van Line companies and a representative from each will contact you.

* denotes a required field

Contact Information
Transferee‘s name *
Contact person‘s name: *
Daytime phone: - - *
Evening phone: - - *
Email:
Best time to call:
Best day to call:
Best way to contact you: Phone  Email
Contact me before: (mm/dd/yyyy)
University Dept:
Estimated move date: (mm/dd/yyyy)
Moving from:
Address1:
Address2:
City, State Zip: ,   
Moving To:
Address1:
Address2:
City, State Zip: ,   
Services Required (please check all that apply):
Pack Load Deliver Unpack
Household Information:

Number of Bedrooms:

Appliance Services:
Washer
Electric Dryer
Gas Dryer
Electric Stove
Gas Stove
Freezer
Ice Maker

Other - Please type in any other appliances you may need moved.

Oversized Items:

Auto Piano

Other - Please type in any other oversized items that will need to be moved.

Warehouse Services

Length of Storage

Insurance:

Please let us know any additional information, which will help us serve you better.

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