1. Full name and phone number.

2.- Your email.

3.- Home address.

4. Loading address if different from home address. (For example: a storage unit)

5. Will you be present the day of the loading of your HHG?

6. How many members of the family are coming with you?

7. Who is going to be the principal visa holder and who will be the dependent or are you having independent visas?

8. What is your visa status: For example, is your visa stamped in passport, in process (include who is doing the visa)?

9. Have you always lived in your country? If not, please let me know other countries in which you have lived.

10. If you are in Ecuador and you will not be present in your home country to load your HHG, when was the date of your last entry to Ecuador?

11. When do you plan to move permanently to Ecuador?

12. What do you plan to ship: a 20' or 40' container, pallets or a liftvan? Circle one.
20 ft container40 / 40HC containerPalletLiftvan

13. What is your final destination in Ecuador? If you don’t have a final address please provide the city where the HHG will be unloaded.

14. If you have a final place, please provide the next information.
a)House or apartment
b)If apartment, which floor?
c)Does the building have an elevator

15. Are you bringing any of the following heavy items?
Work tools or machinery
Piano
Safe
Other

16. Comments or additional information

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