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Coordinator Request Form

 

 

To request coordinator services please complete this form. (* indicates required fields) You will be contacted to confirm receipt and review your requests.
   
Utility Connections and Disconnections apply only to Connecticut & Rhode Island. While HOMEefficient can not offer utility services outside of the state, we can offer Moving Services on a national basis.
   
Eight business days are requested to process your services.
 
Please feel free to contact us with any questions or check our FAQ link.
 
My Prudential Connecticut Realty Sales Executive:  (Select your agent from the drop down list, agents are ordered by last name)
My Contact Information:
  E-Mail Address *
  First Name *
  Last Name *
  Current Home Phone *
  Current Office Phone Ext:
  Current Cellular Phone
  Current Fax Number
 
My Spouse/Co-Owner Information:
  First Name
  Last Name
  Current Office Phone
 
My Current Address:
  Ownership
  Address *
  City *
(non-US Residents type full address here)
  State *
  ZIP Code *
 
My New Address:
  Ownership
  Address *
  City *
(non-US Residents type full address here)
  State *
  ZIP Code *
  Current Owner of Your New Home
  Is This Home New Construction?
   
Date to turn off utilities at my current address: (mm/dd/yyyy)
Date to turn on utilities at my new address:
   
I am interested in Moving Services:
   Auto
   
I am interested in a complimentary Homeowners/Auto Insurance Quote:
 
Please Assist Me with these Connection Services
  Electric  
  Natural Gas  
  Oil  
  Propane  
  Telephone/Local  
  Garbage Removal Information
  Cable (Assistance available in certain areas) 
  Internet Access  
  Locksmith Rekeying 
  Security System/Monitoring 
  Existing System 
  New System 
   
Please Assist Me to Disconnect These Services: Currently Provided By:
  Electric
  Gas
  Telephone/Local
  Garbage Removal
  Cable companies in Connecticut and Rhode Island will not allow third parties to order disconnection of service, due to the return of equipment involved. If you are moving within the same cable company service area, HOMEEfficient can assist you.
 
Included with your services we will provide links/information for the following Change of Address forms:
  Post Office
  DMV (CT Only)
  Dept of Revenue (CT Only)
  Voter Registration (CT Only)
 
Please Contact Me About These Additional Services:
  Carpet & Flooring/Floor Refinishing/Carpet Cleaning
  Air Duct Cleaning
  Home Warranty
  Chimney Cleaning/Inspection/Repair
  Home-Delivered Water
Please visit our Vendor Resource Directory for Additional Services.
  Window Treatments/Shades/Blinds
  Pet Boarding
  Pet Containment Underground Fencing
  New Appliances
  Home Theater
  Hearth & Fireplace
 
    
Additional Comments:
 
IMPORTANT - PLEASE READ THIS AUTHORIZATION CAREFULLY:
I authorize HOMEEfficient as my/our agent to arrange for or discontinue the above requested services, with the understanding that I will be solely responsible to the respective service providers for all charges incurred now and/or in the past or future, from which I agree to hold HOMEEfficient harmless. I agree to inform HOMEEfficient immediately of any corrections or changes to my/our order, or if settlement does not occur as scheduled. HOMEefficient is a division of Prudential Connecticut Realty and may receive promotional consideration from some suppliers.
By pressing the 'Submit' button I acknowledge that I have read and agree with the above authorization.
 
We will contact you shortly to review your activation request. If you have not heard from us within one business day, please give us a call at (866) 811-5214.