| Company Name | |
| Company Phone Number | ( ) - - |
| Company Website | http:// |
| Employee Name | Mr./Ms. |
| Employee Phone Number | ( ) - - |
| Employee E-mail Address | @ |
| Reference Number | |
| |
| LICENSING, INSURANCE & REPUTATION |
| Are you a member of the BBB? | |
| Are you a member of the AMSA? | |
| Are you licensed with the FMCSA? | |
| Do you have the appropriate state licensing? |  Yes | No | License Number: __________________ |
|
| Do you have a USDOT Number? | | Yes | No | License Number: __________________ |
|
| |
| MOVE COSTS |
| Estimate | $ |
| What type of estimate is this? | | Nonbinding | Binding | Binding not-to-exceed |
|
| Are loading and unloading included? | | Yes | No |
|
| Is packing included? | | Yes | No |
|
| Is furniture breakdown/setup included? | | Yes | No |
|
| Do you have auto transport services, and if so, how much do they cost? | |
| What type of protection coverage is included? | |
| How can I purchase additional coverage? | |
| Is this estimate for a full-service move? | | Yes | No |
|
| Given my apartment/condo/house's location and layout, will any of the following fees apply to me? |
| Flight charge/stair carry | Long haul/long carry |
| Shuttle charge | Other charges |
|
| Are mileage, taxes, tolls, and other related expenses included? |
| Mileage | Taxes |
| Tolls | Other expenses |
|
| What are the rates? | |
| Is there a fuel surcharge? | | Yes | No |
|
| How much is it? | |
| Do you supply wardrobe boxes to use for free? | | Yes | No |
|
| Is there any free storage available? | | Yes | No | Length of time: days |
|
| If I'm unable to sign for the shipment, is there a charge for redelivery or storage handling? | | Yes | No | Rate: $_________________ |
|
| Is a deposit required before the move? | | Yes | No | Amount: $________________ |
|
| Amount or percentage due at time of pickup | $_______________________ OR _____________________% |
| Amount or percentage due at time of delivery | $_______________________ OR _____________________% |
| How is the shipment weighed? | | Weight | Volume | Time | Distance |
|
| Estimated weight/volume/time required for shipment | _______________________ lbs/cubic feet/man-hours |
| Do you have a shipment minimum? What is it? | |
| Do you charge extra to rent blankets, dollies, and other equipment? | |
| Do you charge extra for packing supplies? | |
| How much will I save by booking early? How early do I need to book? | | Yes | No | Weeks in advance:_______ |
|
| |
| MISCELLANEOUS |
| Number of days until delivery is made | | 1-2 | 3-6 | 7-10 | 11-15 | ________ |
|
| Estimated percentage of claims for similar (local, long-distance, or international) moves | _____________________________________ % |
| Is there anything else I should be aware of in terms of costs or other important areas before moving with you? | |