* Required fields
Name *
E-mail Address *
Home Phone *
Alternate Phone
ESTIMATED MOVE DATE (mm/dd/yy) *
Moving From: (Give Complete Physical Adress with ZIP) *
Type of Residence Moving From: *
Apartment/Condo - Ground Floor
Apartment/Condo - 2nd Floor
Apartment/Condo - 3rd Floor
Single Family Home - 1 story
Single Family Home - 2 story
Other
Moving To: (Give Complete Physical Adress with ZIP) *
Type Of Residence Moving To: *
Apartment/Condo - Ground Floor
Apartment/Condo - 2nd Floor
Apartment/Condo - 3rd Floor
Single Family Home - 1 story
Single Family Home - 2 story
Other
LIVING ROOM ITEMS TO MOVE? *
Portable TV…………………………………………………………
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1
2
3
TV Stand…………………………………………………………….
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1
2
3
Console TV………………………………………………………….
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1
2
3
Big Screen TV………………………………………………………
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1
2
3
VCR/DVD……………………………………………………………
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1
2
3
Stereo………………………………………………………………..
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1
2
3
Stereo Cabinet……………………………………………………..
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1
2
3
Console Cabinet……………………………………………………
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1
2
3
Pc Comp. Stereo……………………………………………………
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1
2
3
Entertainment Center………………………………………………
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1
2
3
Wall Unit…………………………………………………………….
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1
2
3
Bookcase……………………………………………………………
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1
2
3
Curio Cabinet……………………………………………………….
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1
2
3
Coffee Table………………………………………………………..
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1
2
3
Sofa Table…………………………………………………………..
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1
2
3
End Table……………………………………………………………
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1
2
3
4
5
6
7
8
9
Arm Chair……………………………………………………………
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1
2
3
4
5
6
7
8
9
Recliner………………………………………………………………
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1
2
3
4
5
Rocker……………………………………………………………….
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1
2
3
3-Cushion Sofa……………………………………………………..
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1
2
3
Hide-A-Bed Sofa……………………………………………………
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1
2
3
Love Seat……………………………………………………………
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1
2
3
Pc Sofa Pit Group…………………………………………………..
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1
2
3
Ottoman……………………………………………………………..
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1
2
3
Grandfather Clock………………………………………………….
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1
2
3
Wall Mirror…………………………………………………………..
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1
2
3
4
5
Pictures………………………………………………………………
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1
2
3
4
5
6
7
8
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39
40
Lamps………………………………………………………………..
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1
2
3
4
5
6
7
8
9
Floor Lamp…………………………………………………………..
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1
2
3
4
5
6
7
8
9
OTHER…………………………………………………………………
OTHER…………………………………………………………………
OTHER…………………………………………………………………
Are there any important information or care instructions for any of the items listed in the Living Room section? Are there any items designated by a (°) symbol that requires dissasembly or disconnection? Please make notes here:
BEDROOM ITEMS TO MOVE? *
King Size Bed °……………………………………………………..
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1
2
3
Queen Size Bed°……………………………………………………
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1
2
3
Full Size Bed°……………………………………………………….
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1
2
3
Twin Size Bed°……………………………………………………...
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1
2
3
4
5
6
Bunk Bed°……………………………………………………………
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1
2
3
Water Bed°…………………………………………………………..
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1
2
3
Trundle Bed………………………………………………………….
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1
2
3
Dresser……………………………………………………………….
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1
2
3
4
5
Mirror (Detached) °………………………………………………….
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1
2
3
4
5
Chest of Drawers……………………………………………………
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1
2
3
4
5
Armoire or Wardrobe °……………………………………………...
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1
2
3
4
5
Nightstand……………………………………………………………
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1
2
3
4
5
6
7
8
Cedar Chest or Trunk……………………………………………….
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1
2
3
Crib……………………………………………………………………
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1
2
Changing Table°…………………………………………………….
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1
2
Small Desk…………………………………………………………..
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1
2
3
Toy Chest……………………………………………………………
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1
2
3
Vanity…………………………………………………………………
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1
2
3
OTHER…………………………………………………………………
OTHER…………………………………………………………………
Are there any important information or care instructions for any of the items listed in the Bedroom section? Are there any items designated by a (°) symbol that requires dissasembly or disconnection? Please make notes here:
DINING ROOM ITEMS TO MOVE? *
Glass Dining Table………………………………………………….
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1
2
Wooden Dining Table………………………………………………
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1
2
Dining Chairs………………………………………………………..
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1
2
3
4
5
6
7
8
9
10
11
12
China Cabinet (1 piece)……………………………………………
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1
2
China Cabinet (2 piece)……………………………………………
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1
2
Bar……………………………………………………………………
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1
Bar Stools……………………………………………………………
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1
2
3
4
5
6
Buffet…………………………………………………………………
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1
Hutch…………………………………………………………………
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1
2
Étagère………………………………………………………………
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1
2
OTHER…………………………………………………………………
OTHER…………………………………………………………………
Are there any important information or care instructions for any of the items listed in the Dining Room section? Are there any items designated by a (°) symbol that requires dissasembly or disconnection? Please make notes here:
APPLIANCES TO MOVE? *
Refrigerator………………………………………………………….
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1
2
Freezer°……………………………………………………………..
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1
2
Washer………………………………………………………………
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1
2
Dryer°………………………………………………………………..
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1
2
Microwave…………………………………………………………...
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1
2
Microwave Stand……………………………………………………
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1
2
Stove…………………………………………………………………
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1
2
Vacuum………………………………………………………………
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1
2
Ironing Board………………………………………………………..
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1
2
Mop & Broom………………………………………………………..
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1
2
Sewing Machine……………………………………………………..
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1
2
OTHER…………………………………………………………………
OTHER…………………………………………………………………
Are there any important information or care instructions for any of the items listed in the Appliances section? Are there any items designated by a (°) symbol that requires dissasembly or disconnection? Please make notes here:
OFFICE FURNITURE TO MOVE? *
Office or Roll-Top Desk……………………………………………..
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1
2
Desk Extension°……………………………………………………..
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1
2
Desk Chair……………………………………………………………
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1
2
Credenza………………………………………………………….…..
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1
2
Two Drawer Filing Cabinet………………………………………….
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1
2
Four Drawer Filing Cabinet………………………………………….
-
1
2
Conference Table…………………………………………………….
-
1
2
Conference Table Chairs…………………………………………….
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1
2
3
4
5
6
Drafting Table…………………………………………………………
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1
2
Copier………………………………………………………………….
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1
2
OTHER…………………………………………………………………
OTHER…………………………………………………………………
Are there any important information or care instructions for any of the items listed in the Office section? Are there any items designated by a (°) symbol that requires dissasembly or disconnection? Please make notes here:
MISC ITEMS, SPORTS/EXERCISE EQUIPMENT, OR OUTDOOR EQUIPMENT TO BE MOVED? *
Bicycle…………………………………………………………………
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1
2
3
4
Rowing Machine……………………………………………………...
-
1
Exercise Bike………………………………………………………….
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1
2
Exercise Bench……………………………………………………….
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1
2
Weight Set…………………………………………………………….
-
1
2
Patio Furniture…………………………………………………………
-
1 Table/4-chair set
Other (Please specify in this section's Comment box)
Lawn Mower……………………………………………………………
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1
2
Wardrobe………………………………………………………………
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1
2
Pt. of Clothes……………………………………………...................
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1
2
3
4
5
6
1-Man Boxes………………………………………………………….. *
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1
2
3
4
5
6
7
8
9
10
11
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13
14
15
16
17
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33
34
35
36
37
38
39
40
2-Man Boxes………………………………………………………….. *
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Piano – Baby Grand………………………………………………….
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1
2
Piano – Upright………………………………………………………..
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1
2
Pool Table……………………………………………………………..
-
1
Glass Tops…………………………………………………………….
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1
2
3
4
5
6
Glass Shelves…………………………………………………………
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1
2
3
4
5
6
Area Rugs……………………………………………………………..
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1
2
3
4
5
Large Plants……………………………………………………………
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1
2
3
4
5
Bar-B-Que………………………………………………………………
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1
2
3
OTHER…………………………………………………………………
OTHER…………………………………………………………………
OTHER…………………………………………………………………
OTHER…………………………………………………………………
Are there any important information or care instructions for any of the items listed in the Miscellaneous section? Are there any items designated by a (°) symbol that requires dissasembly or disconnection? Please make notes here:
