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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
Qty Kitchen
Dinning Rm
Qty Basement
Qty Office / Shop
Bookcase Armoire Bakers Rack Baby Carriage Bar BQ / Grill
Bookcase, Section Bassinet Bench Boat - Canoe Bike
Chair, Arm Crib Buffet Boat - Kayak Garbage Can
Chair, Occasional Bed - Single Chair, Dining Room Card Table Set Glider
Chair, Overstuff Bed - Youth Chair, High Chair - Folding Hose
Chair, Recliner Bed - Double Chair, Kitchen Clothes Basket Hot Tub
Chair, Rocker Bed - Queen China Cabinet Cooler Ladder - Extension
Chair, Straight Bed - King Corner Cabinet Cot Ladder - Step
Clock, Grandfather Bed - Bunk / Trundle Curio Cabinet Fan Lawn Cart
Clock Mantle / GM Bed - Water, Assembled Hutch Foot Locker Lawn Chair
CD / Video Rack Bed - Water, Disass Ironing Board Golf Bag Lumber
Day Bed Bed - Rollaway Kitchen Cabinet Gun Cabinet Mower - Push
Desk, Small Bench, Vanity Mircrowave Cart Metal Shelves Mower Lawn
Desk, Secretary Bookcase - Large Roaster Pet Cage Mower - Riding
Entertainment Center Bookcase, Section Serving Cart Ping Pong Table Outdoor Sculpture
Fireplace Equipment Cedar Chest Stool Pool Table Outdoor Tool
Foot Stool Chair, Boudoir Table, Dining Room Power Tool Patio Chair
Hall Chest Chair, Childs Table, Kitchen Sports Equipment Patio Table
Lamp, Pole Chair, High Waste Basket Storage Cabinet Picnic Bench
Magazine Rack Chair, Rocker Water Cooler Suitcase Picnic Table
Music Cabinet Changing Table Tea Cart Table - Folding Planter - Large
Picture Clothes Tree Utility Cabinet Table - Utility Planter - Small
Piano - Spinet
Computer Pieces     Tackle Box Portable BB Hoop
Piano - Upright Credenza APPLIANCES   Tool Chest Sand Box
Piano - Baby Grand Desk - Large Air Conditioner Toy Chest Sled
Piano - Parlor Grand Desk - Small Clothes Washer Toys, Large Snow Blower
Plant - Large Dresser, Chest Compactor Truck Spreader
Plant - Small Dresser, Double Dehumidifier Work Bench Swing Set
Radio, Table Dresser, Tripe Dishwasher     Tires
Rug, Large Roll Exercise Equipment Dryer, Electric OWNER PACKED BOXES   Toys - Plastic
Rug, Small File Cabinet - 2 Drawer Dryer - Gas     Tricycle
Sofa - 2 Cusion File Cabinet - 4 Drawer Freezer, <10 cf Dishpack 5.1 Umbrella
Sofa - 3 Cusion Lateral 2 Drawer Freezer, 11-16 cf Book Box 1.5 Wagon, Childs
Sofa - 4 Cusion Lateral 4 Drawer Freezer, >16 cf Medium Box 3.1 Wheel Barrow
Sofa - Sectional Fire File 4 Drawer Humidifier Large Box 4.5    
Sofa - Hide-A-Bed Futon Microwave X-Large Box 6.1    
Sofa - With Recliners Hamper Refrigerator - Dorm Small Mirror    
Stereo Night Table Regfrigerator < 7 cf Large Mirror    
Speakers Playpen Refrigerator 7-10 cf Wardrobe    
Stereo Cabinet Rug, Large Refrigerator > 10 cf Lamp    
Table, Coffee / End Rug, Small Stove / Range        
Table, Drop / Occas Sewing Cabinet Vacuum Cleaner        
TV - (19" or Less) Sewing Machine EXERCISE EQUIP      
TV - (20" to 40") Table, Child Elliptical Trainer    
TV - (Over 40") Vanity Treadmill Other
TV Large Screen Wardrobe, Small Stair Step Other
VCR DVD Wardrobe, Large Rower Other
TV / Snack Trays     Universal Other
TV Stand SHOP TOOLS       Other
    Drill Press     Other
    Table Saw    
    Band Saw        
    Air Compressor        

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