Current City
Current State
Current Zip
Relocation City
Relocation State
Relocation Zip
When are you planning to move?
Current Residence
House Apartment Condo Office Other
If other, what type of residence do you currently reside in?
Future Residence
House Apartment Condo Office Other
If other, what type of residence are you moving to?
Does either residence have stairs?
No Stairs One has Stairs Both have Stairs
First Name
Last Name
Email Address - this is required so we may contact you
Phone Number
Cell Phone
Other Contact
Please feel free to provide any questions or comments you may have:
Living Room:
Arm Chair Baby Grand Piano Book Case Bureau
Carpet & Rug Clock Grand Father Coffee Tables Cupboard Large
Cupboard Small Curtain End Table Folding Chair
Grand Piano Lamps Floor or Pole Lazy Boy (Chair) Magazine Rack
Occasional Chair Pictures Love Seat Sofa (3 Seater)
Sofa Bed Sofa Sectional (per section) Stereo / Hifi - Mid Stereo /HiFi - Large
Television up to 20" Television 21" - 29" Television 30" - 39" Television 40" - 49"
Television 50" or larger Television Table Upright Piano Video
Wall Unit Large Wall Unit Small
Bedroom
Bed, bunk (Set of 2) Bed, double Bed, single Bed, king
Bed, queen Bed, rollaway Bookshelves Section Cedar Chest
Dresser, Chest of Drawers Ironing Board & Iron Side Tables Wardrobe Boxes (30 hangers)
Wall Mirror
Kitchen
Box, Dish-Pack Box, Large Box, Medium Box, Small
Breakfast Suite, Chairs Breakfast Table Chair, High Kitchen Cabinet
Microwave Oven Serving Cart Stool Table
Utility Cabinet
Dining Room
Buffet Total China Cabinet Corner Cabinet Dining Chair
Dining Table (large or glass) Dining Table Mid Dining Table Small
Appliances
AirConditioner Large AirConditioner Small Dehumidifier Diswasher
Dryer Freezer 10 or less Freezer 11 or 15 Freezer 16 or Over
Microwave Range, 20" Wide Range, 30" Wide Range, 36" Wide
Refrigerator(CuCp) 6cu. ft. or less Refrigerator(CuCp) 7 to 10 cu.ft. Toaster Oven Trash Compactor
Vacuum Cleaner Washing Machine
Miscellaneous
Baby Carriage Barbecue or Portable Grill Bicycle Chair, Lawn
Chair, Porch Child's Wagon Computer Fan
Filing Cabinet Cardboard Filing Cabinet 2 doors Filing Cabinet 4 doors Heater
Ladder, Extension Lawn Mower Office Desk Outdoor Swings
Picnic Table Ping Pong Table Plastic Shelves Pool Table
Power Tool Metal Shelves Tire Tool Tower
Trash Can Tricycle Utility Table Video Game Console
Piano Info
Vertical Grand Player Speakers
No Yes
No Yes
No Yes
No Yes
No Yes
Are there stairs?
Yes No How many steps/flights?
Additional items to move, not listed above. Please be specific.
