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Customer Information
Name Home Phone
Address Work Phone
City State ZIP Code Cell Phone
E-Mail Fax Number
 
New Address  
New City New State New ZIP  
Approx. Move Date  
 
Distance (in ft) from where the truck can park to your front door: Current Home/Apt New Home/Apt
Number of flights of stairs to current front door (Over 8 steps): Current Home/Apt Elevator Available?
Number of flights of stairs to new front door (Over 8 steps): New Home/Apt Elevator Available?
How would you like to be contacted with your price?      
How did you hear about us?
Special Notes:      
Living Rm
Family Rm		 Qty Bedroom
Den/Office		 Qty Kitchen
Dinning Rm		 Qty Basement
Attic/Misc.		 Qty Office / Shop
Misc.		 Qty
Bar - Portable Armoire Bench Plastic Bins - Med. Bar BQ Gril Small
Bench Bed - Single Buffet Plastic Bins - Small Bar BQ Grill Large
Bookcase Bed - Youth Chair, Dining Room Boxes - Ex. Large Bike
Bookcase, Section Bed - Double Chair, High Boxes - Large Garbage Can
Chair, Arm Bed - Queen Chair, Kitchen Boxes - Medium Glider
Chair, Occasional Bed - King China Cabinet Boxes - Small Hose
Chair, Overstuff Bed - Bunk / Trundle Corner Cabinet Mirror Packs Ladder Extension
Chair, Recliner Bed - Water, Disass Curio Cabinet Card Table Set Ladder Step
Chair, Rocker Bed - Rollaway Hutch Chair, Folding Lawn Cart
Chair, Straight Bench, Vanity Ironing Board Clothes Basket Lawn Chair
Clock, Grandfather Bookcase - Large Kitchen Cabinet Cooler / Ice Chest Lawn Mower
CD / Video Rack Bookcase - Section Microwave Cart Cot Lumber
Daybed Cedar Chest Roaster Fan Metal Shelves
Desk, Small Chair, Boudoir Serving Cart Foot Locker Outdoor Sculpture
Desk, Secretary Bed - Water, Assem. Chair, Childs Golf Bag Outdoor Tools
Electronics Chair, Rocker Stool Gun Cabinet Chair Aluminum
Entertainment Center Clothes Tree Table, Dining Room Metal Shelves Patio Chair
Fireplace Equipment Bredenza Table Leaf Pet Cage Patio Table
Footstool Bassinet Chair, High Foosball Table Umbrella
Hall Chest Changing Table Table, Kitchen Ping Pong Table Picnic Bench
Lamp, Pole Crib Leaf Pool Table - Slate Picnic Table
Magazine Rack High Chair Waste Basket Pool Table - Other Planter - Large
Music Cabinet Playpen Water Cooler Power Tool Planter - Small
Picture Desk - Large Tea Cart Sports Equipment Portable BB Hoop
Piano - Baby, Upright Computer Pieces Appliances   Storage Cabinet Riding Mower
Piano - Parlor Grand Desk - Small Air Conditioner Suitcase Sandbox
Piano - Spinet Dresser, Single Clothes Dryer Table - Folding Storage Cabinet
Plant - Large, Live Dresser, Chest Clothes Washer Utility Cabinet Swing Set
Plant - Artificial Dresser, Double Wash / Dry Combo Table, Utility Tires
Plant - Small, Live Dresser, Triple Compactor Tackle Box Tricycle
Plant - Small, Fake Exercise Equipment Dehumidifier Tool Chest Umbrella
Radio, Table File Cabinet - Large Dishwasher Toy Chest Wagon, Childs
Rug, Large Roll File Cabinet - Small Freezer, <10 cf Toys - Large Wheel Barrow
Rug, Small File Cabinet - Lateral Freezer, 11-16 cf Trunk X-mas Tree
Sofa - 2 Cushion File Cabinet - Lateral Freezer, >16 cf Work Bench Fern / Plant Stand
Sofa - 3 Cushion Futon Humidifier Walker    
Sofa - 4 Cushion Floor Lamp Microwave Clothes Rack    
Sofa - Hide-A-Bed Hamper Refrigerator, <7 cf Plastic Bins - Med.    
Sofa - With Recliner Hanging Clothes / 2ft Refigerator, 7-10 cf Additional    
Speakers Mirror Refrigerator, >10 cf Waste Basket    
Stereo Cabinet Night Table Stove / Range Filing Cbt., Crdbrd    
Table Coffee / End Rug, Large Vacuum Cleaner        
Table, Drop / Occas. Rug, Small Table, Child        
TV - (19" or Less) Sewing Machine - C            
TV - (20" - 40") Sewing Machine - P            
TV - (Over 40") Vanity            
TV / Snack Trays Wardrobe, Small            
TV Stand Wardrobe, Large     Other
TV Table         Other
Curio Cabinet         Other
Wicker Settee         Other
Telephone Stand         Other
TV Console         Other
TV, Table Model            
               

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