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GENERAL
INFORMATION

Move Date

First Name

Last Name

Company

Home Telephone

Work Telephone

Fax

Email
ORIGINATION
INFORMATION

Address

City

Other City *

State

Zip Code

Flights of Stairs


Elevator Use?

Long Walk in Excess of


Sloped Path?
EXTRA STOP
INFORMATION

Address

City

Other City *

State

Zip Code

Flights of Stairs


Elevator Use?

Long Walk in Excess of


Sloped Path?
DESTINATION
INFORMATION

Address

City

Other City *

State

Zip Code

Flights of Stairs


Elevator Use?

Long Walk in Excess of


Sloped Path?

Please enter numeric quantities in the following fields.

LIVING ROOM
Sofa Loveseat Hide-a-Bed Sectional Futon
Piano Bench Spinet Piano * Upright Piano * Baby Grand Piano * Concert Grand Piano *
TV 25"-28" TV 29"-34" TV 35"-40" TV 41"-52" Large Screen TV > 52" *
Aquarium 10-20 GAL Aquarium 21-40 GAL Aquarium 41-60 GAL Aquarium 61-75 GAL Aquarium > 75 GAL *
Organ * Entertainment Center Oversized Entertainment Center (1 Pc.) * Bookcases Recliners, Arm-Chairs, Rockers
Ottomans or Footstool Coffee or End-Table Console TV or Stereo Portable TV TV Stand
Stereo Components, Speakers Floor Speakers Floor Lamps Stereo Cabinet Wall Mirror
Standing Mirror Sofa Size Picture Shrunk * Sofa Table

BEDROOM
King or Queen Size Bed ** Full Size Bed ** Twin Size Bed ** Bunk Bed ** Water Bed **
Trundle Bed ** Sleigh Bed ** Captains Bed ** Canopy Bed ** Platform Bed **
Poster Bed ** Bridge Bed ** Day Bed ** Oversize Head/Footboard ** Dresser
Triple Dresser Mirror (Detached) ** Chest of Drawers Armoire or Wardrobe (Empty) Oversize Armoire/Wardrobe (Empty) *
Nightstand Cedar Chest or Trunk Crib and/or Changing Table ** Linear Feet of Clothes (on rod) Small Desk
DINING ROOM
Dining or Kitchen Table Dining Chairs or Bar Stools China Cabinet (1 or 2 pieces) Buffet or Server Glass Table Top
Marble Table Top *







KITCHEN
Stove or Oven ** Refrigerator or Freezer ** Washer or Dryer ** Microwave Microwave Stand
OFFICE
Office or Roll-Top Desk Desk Extension ** Desk Chair Desk Mat Credenza
2 Drawer Lateral File Cabinet 3 Drawer Lateral File Cabinet 4 Drawer Lateral File Cabinet 5 Drawer Lateral File Cabinet 2 Drawer Fireproof File Cabinet *
4 Drawer Fireproof File Cabinet * 2 Drawer Lateral Fireproof File Cabinet * 4 Drawer Lateral Fireproof File Cabinet * 2 Drawer File Cabinet 4 Drawer File Cabinet
Conference Table * Drafting Table Copier Computer Table Hutch
Printer Stand Computer Components ** Gun Cabinet Gun Safe (Non-Fireproof) Fireproof Gun Safe *
Floor Safe * Full Size Copier *
MISCELLANEOUS
Boxes Less than 50 lbs. Boxes More than 50 lbs. Glass Tops Glass Shelves Marble Tops
Area Rugs Large Plants Small Plants Sewing Machines Bar-B-Que or Bicycle
Bird Bath * Ironing Board or Vacuum Vanity Lawn Mower Metal Shelf
Curio Cabinet Etagere' Hall Tree Step Ladder Folding Ladder
Extension Ladder * Plant Stand Work Bench * Rolling Toolchest Yard Tools (Non-Electric)
Plastic Patio Table Plastic Patio Chairs Iron/Wood Patio Table Iron/Wood Patio Chairs Patio Lounge Chair
Patio Swing/Glider Swing Concrete Table * Concrete Bench * Canopy ** Floor Lamp
Exercise Machine *







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