Estimated Costs for Services
Checkbox to choose binding or nonbinding estimate.
- Origin Address
- Customer
- Address
- City/State/Zip
- Contact Number
- Packing Date
- Agreed Pick-up Date
- Agreed Delivery Date
- Destination Address
- Contact Person (if different)
- Address of Intermediate Stops
- Contact Number
Payment
The customer and carrier agree that payment, at time of delivery, will be made by customer.
Payment types: This is space for a list of payment types.
Important Notice
A nonbinding estimate covers only the articles listed. If it is not binding, the cost of the move may exceed the estimate. If you request additional services to complete the move or add articles to the inventory, the household goods mover must prepare a supplemental estimate which will change the amount of the original estimate. Household goods carriers are required by law to collect transportation and other incidental charges. A household goods carrier may not charge more than twenty-five percent above its written non-binding estimate unless the household goods carrier prepares and you sign a supplemental estimate.
Consumer Guide to Moving in Washington State
I certify the carrier provided me with a hard copy or emailed to me the brochure "Consumer Guide to Moving in Washington State."
[Insert signature of customer]
Loss and Damage Protection (Valuation)
The CUSTOMER MUST SELECT AND INITIAL ONLY ONE VALUATION PROTECTION OPTION:
- Basic value protection. I release this shipment to a value of 60 cents per pound per article, at no cost to me. This means I will be paid 60 cents per pound for the net weight of the lost or damaged item, regardless of the actual value of the item.
- Replacement cost coverage with deductible which includes a $300 deductible paid by me. This option will cost $[insert amount]. The value I declare must be at least $9.16 times the net weight of the shipment.
- Replacement cost coverage with no deductible, at a cost of $[insert amount]. The value I declare must be at least $9.16 times the net weight of the shipment.
I declare a lump sum total dollar valuation on this entire shipment of $[insert dollar value].
Estimate
Carrier to select type of estimate.
- This shipment is moving under a binding estimate. This means the shipment is moving under a guaranteed price. The carrier will not charge more than the estimated charges without preparing a supplemental estimate.
- This shipment is moving under a non-binding estimate. If the charges shown on the bill of lading exceed the charges on this estimate, the carrier must release the shipment upon payment of no more than 110% of the estimated charges and will extend credit for at least 30 days at which time the remainder is due. In no case will I be required to pay more than 125% of the estimate, plus any supplemental.
Containers and Packing
| Description | Quantity | Rate | Amount | |||
|---|---|---|---|---|---|---|
| This is space for a list. The sample contains specific boxes and cartons with sizes for typical items like lamps and mattresses to indicate what packing materials the customer purchased. | ||||||
| Description | Quantity | Rate | Amount | |||
|---|---|---|---|---|---|---|
| This is space for a list. The sample contains specific boxes and cartons with sizes for typical items like lamps and mattresses to indicate what the movers packed for the customer. | ||||||
Estimated Costs of Services
In this section on the PDF, there is a list of services and there is another column next to it for estimated charges when the total is calculated for each service. This has been simplified for this web page.
Valuation Charges
- Basic Valuation, 60 cents per pound per article: No Charge
- Replacement cost with $300 deductible [insert amount] at [insert rate] per $100 declared value: $[insert total]
- Replacement cost with no deductible [insert amount] at [insert rate] per $100 declared value: $[insert total]
Storage
- [insert pounds] pounds @ $[insert rate] per 100 pounds, for each 30 days or fraction: $[insert total]
- Warehouse handling [insert pounds] pounds @ $[insert rate] per 100 pounds: $[insert total]
- Additional Valuation [insert percentage]% of [insert amount] transportation valuation charge, for each 30 days or fraction: $[insert total]
Hourly Rated Shipments (55 miles or less)
- [insert hours] hours for [insert vans] van(s) and [insert number] workers @ $[insert amount] per hour: $[insert total]
- Overtime: [insert number] workers for [insert hours] hours @ $[insert amount] per hour: $[insert total]
Mileage Rated Shipments (more than 55 miles)
- [insert miles] miles, [insert pounds] pounds @ $[insert amount] per pound: $[insert total]
- Mileage calculation software: [insert software name]
Per-Diem
For shipments moving more than 55 miles that require workers to stay overnight, the carrier may charge per-diem.
- Number of workers needing overnight stay: [insert number]
- Number of overnight stays: [insert number]
- Rate per worker: $[insert amount]
- $[insert total amount]
Other Services & Charges
This is space for individual descriptions of other services and charges and their associated costs (each).
Subtotal: $[insert amount]
Total of All Charges
Total Charges: $[insert amount]
Remarks
This is space for a list of relevant remarks.
[Insert Signature of Carrier Representative]
[Insert Date]
[Insert Signature of Customer]
[Insert Date]