Items 1 to 6: the request
Request number, date of request, To: General Services Administration, the requesting agency, the person making the request and the agency telephone number.
GSA2485
Cost Comparison for Shipping Household Goods
GSA Form 2485, Cost Comparison for Shipping Household Goods, is a General Services Administration form. Its footer reads GSA FORM 2485 (REV. 4-98), and GSA hosts it in its forms library. GSA's page lists FPMR 101-40.203-4C as its authority or regulation.
The form is a request from an agency, addressed To: General Services Administration, for a side by side cost comparison of a household goods shipment under the commuted rate and under the GBL method. The requesting agency gives its name and address, the person making the request and an agency telephone number, then the shipment data: origin, destination, elevators or stair carry needed, the employee relocating, the approximate moving date and the estimated weight. Item 13, mileage, says GSA will determine it. The cost table compares transportation, packing, metropolitan area charges, elevator and stair carry, storage in transit and other services, with totals.
A note says the commuted rate includes an allowance for packing and that, for comparison purpose ONLY, the same amount is used to estimate those costs under the GBL method; actual cost may be higher or lower. The form prints no OMB number and no privacy statement. You can fill it out free in your browser on this page and download the result without an account.

Request number, date of request, To: General Services Administration, the requesting agency, the person making the request and the agency telephone number.
Origin and destination by city, county and state, elevators or flights of stairs at each end, the employee relocating, the approximate moving date, the estimated weight and mileage.
Rate or charge and amount for transportation and for packing and related services, under the commuted rate in columns (b) and (c) and the GBL method in columns (d) and (e).
Metropolitan area allowance or charge and elevator or stair carry at origin and destination, and storage in transit: day 1, day 2 thru 90, warehouse, handling and pick-up or delivery.
Other services, specified, and the totals for each method.
Remarks, using the reverse if more space is needed, then the signature block. Notes at the bottom carry the authority lines and a CWT allowance box.
Enter the request number and date, the requesting agency's name and address, the person making the request and the agency telephone number.
Enter origin and destination, mark elevator Yes or No and the number of flights of stairs at each end, then the employee relocating, approximate moving date and estimated weight. Item 13 says GSA will determine mileage.
For each service, enter the rate or charge and the amount under the commuted rate and under the GBL method. Several rate lines are marked CWT.
Specify any other services in item 19 and enter the totals in item 20.
Use item 21 for remarks, and the reverse if more space is needed. Item 22 takes the signature, name and title of the signer, the date prepared and a GSA control number.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
Item 3, To:, is preprinted General Services Administration. The form prints no street address.
The notes say the commuted rate includes an allowance for packing, and that for comparison purpose ONLY the same amount is used to estimate costs for these services under the GBL method. Actual cost may be higher or lower.
The notes print the commuted rate authority as GSA Bulletin FPMR A-2, Suppl:, followed by a blank, and leave the GBL method authority blank. GSA's page lists FPMR 101-40.203-4C.
The footer reads GSA FORM 2485 (REV. 4-98). The PDF prints no OMB number and no Privacy Act statement.
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Item 4, From:, takes the requesting agency's name, address and ZIP Code.
Item 5 takes their name and title, and item 6 the agency telephone number with area code and extension.
Item 3, To:, is preprinted General Services Administration. Item 13 says GSA will determine the mileage, and item 22E takes a GSA control number.
Item 10 names the employee relocating. The form has no signature line for the employee.
Items 22A to 22E take a signature, the signer's name and title, the date prepared and the GSA control number. The form does not say which office signs.
The form is addressed to GSA and filled in by the agency making the request. These are the parties its blocks name.
The agency’s own page for Form GSA2485.
The official blank form, to print or fill by hand.
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The footer names the General Services Administration and reads GSA FORM 2485 (REV. 4-98). GSA hosts it in its forms library, and its page lists FPMR 101-40.203-4C as the authority or regulation.
Item 4 takes the requesting agency's name and address, and item 5 the person making the request. Item 3 is preprinted To: General Services Administration.
The cost of shipping household goods under the commuted rate and under the GBL method, service by service, with a rate or charge and an amount for each and totals in item 20.
Item 13, Mileage, says GSA will determine it.
The notes say the commuted rate includes an allowance for packing and that the same amount is used under the GBL method for comparison purpose ONLY. Actual cost may be higher or lower.
Item 9, Elevators/Stair Carry Needed, says it does not apply to a single-family dwelling.