Name: *
E-Mail Address: *
City:
State:
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Zip:
Home Phone: *
Work Phone:
Fax:
How Did You Hear About Us?
Best time to contact you: am pm
Estimated move date: *
Address:
Size of apartment: Size Studio 1 Bedroom 2 Bedroom 3 Bedroom Private House Storage
Elevator: Yes No # of Floors:
Will you need: Packing Unpacking Storage
Living Room:
Bookcase
Sofa, loveseat
Cabinet
Sofa, large
Chair, straight
Stereo
Chair, arm
Tables, coffee
Chair, rocker
Tables, end
Chair, overstuffed
TV, up to 30"
Entertainment center, medium
TV, larger than 30"
Entertainment center, large
VCR
Lamps
Piano None Spinet Upright Piano Baby Grand Grand
Pictures
Rugs
Chest, cedar
Dining Room:
Buffet (base)
Chair
Hutch (top)
Server
Cabinet, corner
Rug (small)
Rug (large)
Dining table
Bedrooms:
Bed, single
Dresser, single
Bed, double
Dresser, double
Bed, queen
Dresser, triple
Bed, king
Night table
Bed, bunk (set 2)
Bookshelves (sectional)
TV
Chest, armoire
Nursery:
Bed, youth
Chest, toy
Crib, baby
Table, child's
Appliances:
Aircond/window.sm
Refrigerator (11 cu. ft. or over)
Aircond/window.lg
Vacuum cleaner
Dishwasher
Washing machine
Freezer 10 cf or or less
Dryer
Freezer 10-15
Freezer 16 or over
Refrigerator (6 cu. ft. or less)
Refrigerator (6 cu. ft. or more)
Refrigerator (7-10 cu. ft.)
Kitchen:
Chairs
Microwave cart
Breakfast table
Ironing board
Microwave oven
Porch & Outdoor:
BBQ grill, small
Lounge chairs
BBQ grill, large
Table
Chairs, aluminum
Chairs, metal
Misc:
Bicycle
Exercise equipment
Desk, office
Computers
Filing cab. 2 door
Fine Art
Filing cab. 4 door
Musical instruments
Suitcase
Trash can
Boxes: Estimated number of boxes to be moved Items of extraordinary value: Comments: