Student Relocation Booking Form

Information Requested:

Quote #
Name
Social Security #
Current Address
Phone
E-mail
Expected Date
of Departure

Port of Destination
# Pieces 
  

Crate Size

  (Length x Width x Height)
Other
 
Shipment to be Consigned to:
Name

Phone
Address
DO NOT INSURE MY GOODS
PLEASE ENSURE MY SHIPMENT FOR $

(Minimum $1500.00) @ 4.00 Per 100 Value)

Insurance coverage is subject to a $50 deductible. The insurance carrier will not honor claims for damage such as scratches, chips, or breakage of fragile items which are caused by improper packing.

Comments/ Instructions

 

Personal Effects Inventory:

PKG. NO.

 Description Value Replacement Value
$ $
$ $
$ $
$ $