	121 STILLWATER ROAD, MAHOPAC, NY 10541 1-800-759-4253 \| P 914-241-1711 \| F 914-241-3148 \| email: CAREFUL@MOVEWHALENS.COM

E&I MEMBER REQUEST FOR RELOCATIONS SERVICES

Please fill out this form so we can best serve your needs

Date:
E&I Member Institution:
Authorizing School/Dept.:
From (Authorized Dept. Contact):
Phone:
New employees name (and Spouse Partner if applicable):
Employment Status:	Candidate Accepted Position
For (New Title):
Current address:
Own or Rent:	Own Rent
Additional materials from office/lab or another location:	Yes No
Home Phone #:
Office Phone #:
Cell Phone #:
Current E-Mail:
Any additional pertinent information:
Benefits/Services	Services below are NON-TAXABLE if the relocation is over 50 miles from the old to new residence and incur NO ADDITIONAL MANAGEMENT FEE
Non-taxable services
	Full Service Household Goods Move: containers, packing, moving, unpacking and appliance servicing. Please note any dollar limitations or expenses that must be paid by the employee.
	Storage (if needed) up to 30 days or $
	Automobile transport up to vehicle
	Home Marketing Assistance - for more information visit http://eandi.myhomebenefits.com/
	Home Finding Assistance - for more information visit http://eandi.myhomebenefits.com/
	Mortgage Assistance - for more information visit http://eandi.myhomebenefits.com/
	Pet Relocation (specify # or )

Taxable services	Services below may be TAXABLE ITEMS to the employee if the institution is paying or reimbursing the employee for the services. For more information on taxability issues visit the following link
	Temporary Housing up to days A separate quote will be provided
	Household Goods Storage after 30 days up to days Direct cost only - will be included in household move estimate
	Spouse/Partner Career Counseling - A separate quote will be provided
	Area familiarization tours - No fee if in conjunction with Home Purchase Program, otherwise a fee applies
Click here to submit your request for services to Allied via email or print and fax to 914-241-3148 Attention E&I Desk. Thank you for the opportunity to be of service!
* 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.