ESTIMATE OF CHARGES
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ESTIMATE OF CHARGES Contact Mover at this address and phone Moverʼs Ill.C.C. License Number Pack Date Pickup Date Delivery Date Origin: Destination: Name Consigned to: Address Address Phone Phone Mover’s Liability Before the move begins, the shipper must insert in the space provided on the bill of lading, in (his/her) own handwriting, either declaration of the actual value of the shipment or the words “30 cents per pound per article.” Otherwise, the shipment will be deemed released to a maximum value equal to $2.00 times the weight of the shipment in pounds. Additional tariff charges may apply for value over 30 cents per pound per article. Declaring a released value for goods is not the same as purchasing a policy of insur - ance. Separate insurance may be purchased at an additional charge, for which you will receive a certificate of insurance. Important Notice about Payment In accordance with Illinois law, unless the mover has agreed in writing to credit arrangements, you will be expected to pay for the move at delivery. Payment must be in cash, money order, or cashier’s check. The mover is not required to accept a personal check. The mover has made every effort to estimate accurately the charges for your move, based upon the information you have provided. If the actual tariff charges on the day of the move exceed the charges contained in this written estimate, you will be required to pay at delivery the amount of the estimated cost PLUS 10 percent, at which time the mover will release your goods. You are required by law too pay within 30 days of delivery the balance of the total actual charges. LOCAL MOVE (hourly rates) Packing Charges Other Charges INTRASTATE MOVE (weight-mileage rates - moves more than 35 miles) Total Charges $$ # Chargeable Hours # Personnel # Trucks Travel Time # Hours: Rate: $ Mileage Charge # Miles $ per mile: Valuation Charge: Other Charges: Straight Time Overtime Sunday/Holiday #Hours Rate Ext. #Hours Rate Ext. # Hours Rate Ext. Qty Rate Ext. Qty Rate Ext. Qty Rate Ext. Net weight lbs. Miles: Rate: Valuation Charge: $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Container Description Container Charge Packing Unpacking Total packing charge (see attached packing addendum if appropriate) Extra pickup or delivery charge: Hoisting or Piano Charge: Stair Carry, Elevator, Origin Destination Long Carry Extra Labor: # Personnel: # Hours: Appliance Service Origin Destination: Bulky Item Charge: Storage Date In: Warehouse Handling Charge: Warehouse Valuation Charge: $ per Trip Transit Insurance Policy Charge: Other $ $ $ $ $ $ $ $ $ $ $ $ NOTE TOTAL ESTIMATED CHARGES $ X Estimator’s Signature Code # Date X Customer’s Signature o Customer provided Ill.C.C. required consumer brochure copyright 1998 Illinois Moversʼ and Warehousemenʼs Association Rev 06/06 Form #3575 Re-order from: ILLINOIS MOVERS’ & WAREHOUSEMEN’S ASSOCIATION 40 ADLOFF LANE, STE. 2, SPRINGFIELD, IL 62703-4441 • 217-585-2470 • FAX 217/585-2472 IMPORTANT NOTICE This is not a binding estimate. This estimate covers only the articles and services listed. It is not a warranty or representation that the actual charges will not exceed the amount of the esti - mate. Any additional articles and services added after the written estimate is execut - ed may result in additional charges . Mover will collect charges computed on the basis of rates shown in their lawfully published tariffs at the time of the move, regardless of prior rate quo- tations or estimates made by the mover or its agents Transportation charges are based upon either the weight of the goods transported or the time consumed in transporting the shipment. Special arrangements can be made with the mover for expedited services to guarantee a deliv- ery date for intercity shipments, for which an additional charge normally will apply. As determmined by mover’s tariff, rates may be computed by the hour for moves 35 miles or less from origin to destination, or when origin and des- tination are wholly within the area covered by the counties of Cook, DuPage, Kane, Kendall, Lake, McHenry, and Will. Charges for moves over 35 miles when either or both the origin and destina- tion are outside the aforementioned counties must be computed on weight-mileage basis.
Transcript of ESTIMATE OF CHARGES
ESTIMATE OF CHARGES
Contact Moverat this addressand phone Moverʼs Ill.C.C.License Number
Pack Date
Pickup Date
Delivery Date
Origin: Destination:Name Consigned to:Address Address
Phone Phone
Mover’s LiabilityBefore the move begins, the shipper mustinsert in the space provided on the bill of lading, in (his/her) own handwriting, eitherdeclaration of the actual value of the shipmentor the words “30 cents per pound per article.”Otherwise, the shipment will be deemedreleased to a maximum value equal to $2.00times the weight of the shipment in pounds.Additional tariff charges may apply for valueover 30 cents per pound per article.Declaring a released value for goods is not the same as purchasing a policy of insur-ance. Separate insurance may be purchasedat an additional charge, for which you willreceive a certificate of insurance.
Important Noticeabout Payment
In accordance with Illinois law, unlessthe mover has agreed in writing to credit arrangements, you will beexpected to pay for the move at delivery. Payment must be in cash,money order, or cashier’s check. Themover is not required to accept a personal check.
The mover has made every effort to estimate accurately the charges for yourmove, based upon the information youhave provided. If the actual tariffcharges on the day of the move exceedthe charges contained in this written estimate, you will be required to pay atdelivery the amount of the estimated cost PLUS 10 percent, at which time themover will release your goods. You arerequired by law too pay within 30 daysof delivery the balance of the totalactual charges.
LOCAL MOVE(hourly rates)
Packing Charges
Other Charges
INTRASTATE MOVE(weight-mileage rates - moves more than 35 miles)
Total Charges
$$# Chargeable
Hours
# Personnel
# Trucks
Travel Time # Hours: Rate: $
Mileage Charge # Miles $ per mile:
Valuation Charge:
Other Charges:
Straight Time Overtime Sunday/Holiday
#Hours Rate Ext. #Hours Rate Ext. # Hours Rate Ext.
Qty Rate Ext. Qty Rate Ext. Qty Rate Ext.
Net weight lbs. Miles: Rate:
Valuation Charge:
$
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ContainerDescription
Container Charge Packing Unpacking
Total packing charge (see attached packing addendum if appropriate)
Extra pickup or delivery charge:
Hoisting or Piano Charge:
Stair Carry, Elevator, Origin DestinationLong Carry
Extra Labor: # Personnel: # Hours:
Appliance Service Origin Destination:
Bulky Item Charge:
Storage Date In:
Warehouse Handling Charge:
Warehouse Valuation Charge: $ per
Trip Transit Insurance Policy Charge:
Other
$
$
$$
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$
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$
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NOTE TOTAL ESTIMATED CHARGES $X
Estimator’s Signature Code # Date
X
Customer’s Signature o Customer provided Ill.C.C. required consumer brochurecopyright 1998 Illinois Moversʼ and Warehousemenʼs Association Rev 06/06 Form #3575
Re-order from:ILLINOIS MOVERS’ & WAREHOUSEMEN’S ASSOCIATION40 ADLOFF LANE, STE. 2, SPRINGFIELD, IL 62703-4441 • 217-585-2470 • FAX 217/585-2472
IMPORTANT NOTICEThis is not a binding
estimate.This estimate covers only the articlesand services listed. It is not a warrantyor representation that the actual chargeswill not exceed the amount of the esti-mate. Any additional articles and servicesadded after the written estimate is execut-ed may result in additional charges.
Mover will collect charges computed on the basisof rates shown in their lawfully published tariffs atthe time of the move, regardless of prior rate quo-tations or estimates made by the mover or itsagents Transportation charges are based uponeither the weight of the goods transported or thetime consumed in transporting the shipment.Special arrangements can be made with themover for expedited services to guarantee a deliv-ery date for intercity shipments, for which an additional charge normally will apply.
As determmined by mover’s tariff, rates may becomputed by the hour for moves 35 miles or lessfrom origin to destination, or when origin and des-tination are wholly within the area covered by thecounties of Cook, DuPage, Kane, Kendall, Lake,McHenry, and Will. Charges for moves over 35miles when either or both the origin and destina-tion are outside the aforementioned countiesmust be computed on weight-mileage basis.
MISC.
KITCHEN
APPLIANCES
NURSERY
DINING ROOM
LIVING ROOM BEDROOM Porch & Outdoor
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Bar, Portable 15Bench, Frsd/Piano 5Bookcase 20Bookshelves, Sect. 5Cabinet, Curio 10
Chair, Straight 5
Chair, Arm 10
Chair, Rocker 12Chair, Occasional 15Chair, Overstuffed 25Chest, Cedar 15Clock, Grandfather 20Day Bed 30Desk, SM/Winthrop 22
Desk, Secretary 35
Fireplace Equip. 5Footstool 2Hall Tree Rack 2Hall Tree Large 12Lamp, Floor 3Lamp, Pole 3Magazine Rack 2Music Cabinet 10Piano, Baby Gr/Upr 70Piano, Parlor Gr. 80Piano, Spinet/Console 60Radio, Table 2Rec. Player, Port. 2Rugs, Lg. Roll/Pad 10Rugs, Sm. Roll/Pad 3Sofa, Rattan/Wicker 10Sofa, Sec., Per Sec. 30Sofa, Loveseat 35Sofa, 3 Cushion 50Sofa, Hide, 4 Cush. 60Stereo Component 8Stereo, Console 15Tables, Dropl/Occas 12Tables, Coffee 5Tables, End 5Telephone Stand 5TV, Bigscreen 40TV, Portable 5TV, Table Model 10TV, Console 15TV, Combination 25TV, Stand 3Trunk 5
Bench, Harvest 10Buffet (Base) 30Hutch (Top) 20Cabinet, Corner 20Dining Table 30
Dining Chair 5Server 15
Tea Cart 10Rugs, Large or Pad 10Rugs, Small or Pad 3
Bed Incl Sp/MattBed Rollaway 20Bed, Single/Hollywood 40Bed, Std/Dbl. 60Bed, Queen 65Bed, King 70
Bed, Bunk (Set 2) 70
Bookshelves, Sect. 5
Chair, Boudoir 10Chair, Str/Rocker 5Chaise Lounge 25Chest, Bachelor 12Chest, Cedar 15Chest, Armoire 30
Desk, SM/Winthrop 22Dresser/Vanity Bch 3Dresser, Vanity 20Dresser, Single 30
Dresser, Double 40Dresser, Triple 50Exercise Bike 10Lamp, Floor 3Night Table 5Rug, Large or Pad 10Rug, Small or Pad 3Wardrobe, Small 20Wardrobe, Large 40Waterbed 20
Bathinette 5
Bed, Youth 30Chair, Childs 3Chair, High 5Chest 12Chest, Toy 5Crib, Baby 10Table, Childs 5Playpen 10Rug, Large or Pad 10Rug, Small or Pad 3
AirCond/Wind. Sm. 15
AirCond/Wind. Lg. 20
Dehumidifier 10Dishwasher 20FreezerFreezer 10 or less 30Freezer 11 to 15 45Freezer 16 or Over 60Range 20” Wide 10Range 30” Wide 15Range 36” Wide 30
Refrigerator (CuCp)Ref. 6 cu. ft. or less 30Ref. 7 to 10 cu. ft. 45Ref. 11 cu. ft./over 60Trash Compactor 15Vacuum Cleaner 5Washing Machine 25Dryer 25
Bkft. Suite, Chairs 5Breakfast Table 10Chair, High 5Ironing Board 2Kitchen Cabinet 30Microwave Oven 10
Serving Cart 15Stool 3Table 5Utility Cabinet 10
BBQ Grill, Small 2BBQ Grill, Large 10Chairs, Aluminum 1Chairs, Metal 3Chairs, Wood 5
Gard. Hose & Tools 10Glider or Settee 20Ladder, 6’ Step 3Ladder, 8’ Metal 2Ladder, Extension 8Lawn Mower, Hand 5Lawn Mower, Power 15Lawn Mower, Riding (HP) 35Lawn Edger 3Leaf Sweeper 5Outdoor Child Slide 10Outdoor Child Gym 20Outdoor Dry. Racks 5Outdoor Swings 30Picnic Table 20Picnic Bench 5Roller, Lawn 15Rug, Large 7Rug, Small 3Sand box 10Spreader 2
Table, Small 2
Table, Large 4Umbrella 5Wheelbarrow 8
Baby Carriage 4Barbells lbs.Basket (Clothes) 5Bicycle 5
Tricycle 2
Bowling Ball/Bag 3
Card Table 2Folding Chairs 1Clothes Hamper 5Cot, Folding 10Desk, Office 10Fan 5Fern/Plant Stands 2Filing Cab. Crdbd. 3Filing Cab. 2 door 10Filing Cab. 4 door 20Footlockers 5Game Table 15Golf Bag 4Heater, Gas/Elec. 5Metal Shelves 5Ping Pong Table 40Pool Table Comp. 40Pool Table Slate 100Power Tool Hand Ea. 3Power Tool Stand 15Sewing Mach., Port 10Sewing Mach., Console 10Sewing Mach., w/Cabinet 20Sled 2Suitcase 5Table, Utility 5Tackle Box 1Tire 3Tire w/Rim 5Toolchest, Small 5Toolchest, Medium 10Toolchest, Large 15Trash Can 7
Wagon, Child’s 5
Wastepaper Basket 2Work Bench 20
Total Col. 1
Total Col. 2
WEIGHT ADDITIVE
Total
PCS CUBE
Total This Column
Total Col 1
Total Col 2
Total Cartons
Total
Carr. Own. Tot. TotCarton Pack. Pack. Ctn. Cb. Cb.
Dish-pack 101010
Carton 1.5 1.51.51.5
Carton 3.0 3.03.03.0
Carton 4.5 4.54.54.5
Carton 6.0 6.06.06.0
Wardrobe 10Crib MattressSingle MattressDbl. MattressQn/Kg. MattressMirror CartonCrates
Enter item and cube under “Miscellaneous” inaddition to completing below:
Boat Linear Ft. x 115 = lbs.
Boat Trir. Lin. Ft. x 75 = lbs.
Sailboat Lin. Ft. x 125 = lbs.
Total Wt. Additive
Only the items listed are included in the Total Cost.Any items or additional services added may result inadditional cost.
Shipper Date
Carrier’s Representative
Wt. Factor (lbs/cu. ft.)
Computed Est. Wt.
Total Wt. Additive
Total Est. Weight
TABLE OF MEASUREMENTS
MILBURN PRINTING • 800-999-6690 • www.milburnprinting.com
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