	39 KISCONA ROAD, MOUNT KISCO, NY 10549 1-800-759-4253 \| P 914-241-1711 \| F 914-241-3148 \| email: CAREFUL@MOVEWHALENS.COM

Higher Education

- Household Moving and Related Services

- Lab Relocation Project Management

- High Value Products Transportation

- International Moving

- Higher Education References

- Woman Owned

- Green Initiatives

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PERSONAL RELOCATION 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:	YesNo
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
	Household Goods Move
	Packing containers	Packing	Unpacking
	Storage at movers warehousedays
	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/
	* Required Fields

Whalen's Moving & Storage Co., LLC. will protect our customer's right to privacy and will not share any information about
you to any other organization unless required by law.