HELP-U-MOVE CONTRACT REQUEST FORM

Request for moving services 
Please print this form and fill in the information necessary.  Please note, this form is for mailing and faxing only, it can not be e-mailed.
After you have received a written price quote, please fill out and fax or mail the following to us a long with the $75 deposit:
Mail to:  Help-U-Move  85 Commercial Way, East Providence, RI 02914
OR
Fax to: (401) 434-5178

Please write or type the address you are moving from (origin):

Name:     
Address  
City, State and Zip  
Phone Number - Home  
Pager or cellular    
Phone Number - Work  
Fax Number
Required for us to fax you the contract
         
Email Address           
SPOT DATE
requested drop off day
                                             Weekday's only  (We only drop off &r pickup trailers on weekdays)
PICKUP DATE
requested day we pickup goods
                                     Weekday's only (We only drop off & pickup trailers on weekdays)

Please write or type the address you are moving to (destination):

Address  
City, State and Zip                                                                                                       
Phone Number  
Alternate Contact Number  
Space Quoted  
Price Quoted  

Deposit information: A deposit of $75 is required when reserving a truck.  The deposit is non refundable and will be subtracted from
the final cost of the move.  The deposit can be made with a major credit card or by mailing a check to the above address.

Credit Card

Cardholders Name:  
Card Number:  
Expiration Date:  
Cardholder
Signature:
 

We accept American Express, Discover, VISA & MasterCard

Make checks payable to: Commercial Sales & Marketing or CSM

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