Authorization for Move Form (Employee Move)

THIS FORM MUST BE COMPLETED BY THE UBM OR DEPARTMENT HEAD

The below named person is authorized to be moved to the Louisville area under the terms of the agreement between the University of Louisville and Allied Van Lines/Berger Transfer Storage, Inc.

Name of Employee Moving: (Required)

Email Address: (Required)

Moving From Address: (Required)

City, State, Zip: (Required)

County:

Phone (Office): (Required)

Phone (Residence): (Required)

Speedtype(s) to be charged for the move: (Required)

Department Responsible for Move: (Required)

What portion of the move is the department willing to pay? (Required)

If partial, the maximum amount agreed upon for all approved services is:

If applicable, is the department willing to pay for any of the employees vehicles to be moved (car, truck, van, boat, motorcycle)? (Required)

If applicable, is the department willing to pay for any of the employees storage charges as follows: 1st Day Delivery In Charge (Required)

Daily Storage Charges (Required)

If yes, how many days?

Load and Delivery out of storage to residence charge (Required)

Name of department representative authorizing this move: (Required)

Email Address: (Required)

Phone (Office): (Required)

Title: (Required)

Date: (Required)

Authorization for Move Form (Employee Move)

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