**REQUEST TO MOVE HOUSEHOLD GOODS**

<table>
<colgroup>
<col style="width: 2%" />
<col style="width: 6%" />
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<col style="width: 4%" />
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<col style="width: 17%" />
<col style="width: 0%" />
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<col style="width: 2%" />
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<tbody>
<tr class="odd">
<td colspan="31"><strong>Please TAB to gray areas</strong></td>
</tr>
<tr class="even">
<td colspan="18"></td>
<td colspan="13">To be supplied by Transportation Procurement</td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="18"></td>
<td colspan="3">Carrier:</td>
<td colspan="6">–––––</td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="18"></td>
<td colspan="6">Route Control No:</td>
<td colspan="4">–––––</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="2"><blockquote>
<p>Name</p>
</blockquote></td>
<td colspan="17">–––––</td>
<td colspan="6">Social Security No.</td>
<td colspan="2">–––––</td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="31"><blockquote>
<p>PRESENT LOCATION</p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="5"><blockquote>
<p>Street and No.</p>
</blockquote></td>
<td colspan="22">–––––</td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="8"><blockquote>
<p>City, State, Zip Code:</p>
</blockquote></td>
<td colspan="19">–––––</td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="5"><blockquote>
<p>Home Phone No.</p>
</blockquote></td>
<td colspan="11">(–––) –––––</td>
<td colspan="7">Work Phone No.</td>
<td colspan="7">(–––) –––––</td>
<td></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="9"><blockquote>
<p>No. of rooms occupied</p>
</blockquote></td>
<td colspan="2">–––––</td>
<td colspan="6">Weight, if known</td>
<td colspan="9">–––––</td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="9"><blockquote>
<p>Do you have a freezer?</p>
</blockquote></td>
<td colspan="6">–––––</td>
<td colspan="4">Piano?</td>
<td colspan="7">–––––</td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="10"><blockquote>
<p>Prefer to move on (date)</p>
</blockquote></td>
<td colspan="3">–––––</td>
<td colspan="7">Alternate date</td>
<td colspan="6">–––––</td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="31"><blockquote>
<p><strong>NEW LOCATION</strong></p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="4"><blockquote>
<p>Street and No.</p>
</blockquote></td>
<td colspan="23">–––––</td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="7"><blockquote>
<p>City, State, Zip Code:</p>
</blockquote></td>
<td colspan="20">–––––</td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="28">–––––</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>Short Code</p>
</blockquote></td>
<td colspan="9">–––––</td>
<td colspan="19"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="5"><blockquote>
<p>Travel Order No.</p>
</blockquote></td>
<td colspan="24">–––––</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>Organization</p>
</blockquote></td>
<td colspan="26">–––––</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="5"><blockquote>
<p>Telephone No.</p>
</blockquote></td>
<td colspan="24">–––––</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="6"><blockquote>
<p>Date Completed</p>
</blockquote></td>
<td colspan="8">–––––</td>
<td colspan="8">Transportation Specialist</td>
<td colspan="7">–––––</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="31"><em><strong>Distribution:</strong></em></td>
</tr>
<tr class="odd">
<td colspan="31">Send Page 1 original to Transportation Procurement, WR
3K-C or email to Transportation Procurement</td>
</tr>
<tr class="even">
<td colspan="31">Retain Page 2 for your records</td>
</tr>
<tr class="odd">
<td colspan="31"></td>
</tr>
<tr class="even">
<td colspan="31"></td>
</tr>
</tbody>
</table>

**TRANSPORTATION & STORAGE OF HOUSEHOLD GOODS**

+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
| -   Weight Restrictions:       | 18,000 lbs.                         |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
| -   Transportation:            | Includes packing, crating,          |
|                                | unpacking, and other necessary      |
+--------------------------------+-------------------------------------+
|                                | services                            |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
| -   Carrier's Liability For    | TVA will pay for a declared value   |
|     Loss or Damage             | of \$1.25 per pound                 |
+--------------------------------+-------------------------------------+
| > and Extra Valuation:         | of household goods. The cost of a   |
|                                | declared value per                  |
+--------------------------------+-------------------------------------+
|                                | pound of goods shipped will be      |
|                                | billed to the employee              |
+--------------------------------+-------------------------------------+
|                                | by TVA.                             |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
| -   Rented Truck:              | U-haul type truck or trailer.       |
|                                | Documentation is required           |
+--------------------------------+-------------------------------------+
|                                | showing the weight of goods or      |
|                                | dimensions of the trailer           |
+--------------------------------+-------------------------------------+
|                                | (length, width, height) and         |
|                                | approximately how fully             |
+--------------------------------+-------------------------------------+
|                                | loaded (one-third, one half, etc.)  |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
| -   Temporary Storage:         | 90-day time limit (an additional 90 |
|                                | days may be allowed                 |
+--------------------------------+-------------------------------------+
|                                | under certain conditions)           |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+
| ***CONTACT SHARED RESOURCES 2  |                                     |
| WEEKS PRIOR TO PREFERRED       |                                     |
| MOVING DATE***                 |                                     |
+--------------------------------+-------------------------------------+
|                                |                                     |
+--------------------------------+-------------------------------------+