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Personal Move Service Request Form

If you are paying for your relocation yourself but would like to take advantage
of the Educational & Institutional Cooperative Services contract benefits, complete the form:

Date:

Name (and Spouse/Partner if applicable):

Affiliated Institution:

Current address:

Additional materials from office/lab:

Yes No

Home Phone:

Office Phone #:

Cell Phone #:

Current E-Mail:

Any additional pertinent information:

Services Requested for:

Approximate move date:

# of rooms of furniture
being moved :

Check Desired Services

Packing containers	Packing	Unpacking
Storage at mover's warehouse days
Automobile transport - include vehicle(s) description
Extra pick-ups/deliveries
Home Marketing Assistance - for more information visit http://eandi.myhomebenefits.com/
Home Finding Assistance - - for more information visit http://eandi.myhomebenefits.com/
Temporary Housing - for more information visit http://eandi.myhomebenefits.com/

Berger Transfer & Storage Inc. will protect our customer's right to privacy and will not share any information about you to any other organization unless required by law.