Company Street City St Zip
Contact Email Phone # Fax #

Date of Move Availability: Anytime Specified Time Additional Charges May Apply.
Access Loading Dock Service Elevator Stairs Unpaved Terrain
Access Residential Other

Company Street City St Zip
Contact Email Phone # Fax #

Date of Move Availability: Anytime Specified Time Additional Charges May Apply.
Access Loading Dock Service Elevator Stairs Unpaved Terrain
Access Residential Other

Bill To: Pickup Location Delivery Location Other (Complete Information Below)
Company Street City St Zip
Contact Email Phone # Fax #

Type of Equipment being moved. Click all that apply and Fill in appropriate information.
Monitors Number Size Approx.Wt
Servers Number Size Approx.Wt
Cabinets/Racks Number Size Approx. Wt.
Casters Yes No
 
Populated Yes No
Copiers Number Size Approx. Wt.
  Desktop Console/Stand Alone    
Other Accessories

Special Instructions:

Computer Movers Inc. provides Five Dollars ($5.00) per pound of insurance on all transported goods. If you elect to declare a higher value the charge for that coverage is Fifty cents ($.50) per One Hundred Dollars ($100.00) of declared value.
Extra Insurance Yes No Declared Value

Carrier Liability @ $5.00 per pound Yes No

 
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