Living Room/Family Room Qty Bedroom Den/Office Qty Kitchen/Dining Room Qty Basement Attic/Misc. Qty Office/Shop Misc. Qty
Bar - Portable Armoire Bakers Rack Baby Carriage Bar BQ/ Grill
Bench Bassinet Bench Boxes - Large Bike
Bookcase Bed - Single Buffet Boxes - Small Garbage Can
Bookcase, Section Bed, Youth Chair,Dining Rm Card Table Set Glider
Chair, Arm Bed - Double Chair, High Chair, Folding Hose
Chair, Occasional Bed - Queen Chair, Kitchen Clothes Basket Ladder Extension
Chair, Overstuff Bed- King China Cabinet Cooler Ladder Step
Chair, Recliner Bed-Bunk, Trundle Corner Cabinet Cot Lawn Cart
Chair, Rocker Bed-Water,Ass Curio Cabinet Fan Lawn Chair
Chair, Straight Bed - Water,Disa Hutch Foot Locker Lawn Mower
Clock, Grandfather Bed, Rollaway Ironing Board Golf Bag Lumber
CD/ Video Rack Bench, Vanity Kitchen Cabinet Gun Cabinet Metal Shelves
Day Bed Bookcase-Large Microwave Cart Metal Shelves Outdoor Sculpture
Desk, Small Bookcase, Small Roaster Pet Cage Outdoor Tools
Desk, Secretary Cedar Chest Serving Cart Ping Pong Table Patio Chair
Electronics Chair, Boudoir Stool Pool Table Patio Table
Entertainment Center Chair, Childs Table,Dining Rm Power Tool Picnic Bench
Fireplace Equipm Chair, High Table, Kitchen Sports Equipment Picnic Table
Foot Stool Chair, Rocker Waste Basket Storage Cabinet Planter - Large
Hall Chest Changing Table Water Cooler Suitcase Planter - Small
Lamp, Pole Clothes Tree Tea Cart Table - Folding Port. BB Hoop
Magazine Rack Computer Pieces Utility Cabinet Table, Utility Riding Mower
Music Cabinet Credenza Tackle Box Sand Box
Picture Crib Tool Chest Sled
Piano -Baby,Upr Desk-Large Appliances Toy- Small Snow Blower
Piano, Parlor Gr Desk - Small Air Conditioner Toys - Large Storage Cabinet
Piano - Spinet Dresser, Chest Clothes Dryer Trunk Swing Set
Plant - Large Dresser, Double Clothes Washer Work Bench Tires
Plant - Small Dresser, Triple Compactor Tricycle
Radio, Table Exercise Equipment Dehumidifier Umbrella
Rug, Large Roll File Cabinet- Large Dishwasher Wagon, Childs
Rug- Small File Cabinet- Small Freezer, <10cf Wheel Barrow
Sofa-2 Cushion Futon Freezer, 11-16cf
Sofa-3 Cushion Hamper Freezer, >16cf
Sofa-4 Cushion Hanging Clothes/2 Ft Humidifier
Sofa-Hida-a-bed Mirror Microwave
Sofa-with-Recliners Night Table Refrig <7cf
Speakers Playpen Refrig 7-10cf
Stereo Cabinet Rug, Large Refrig >10cf
Table Coffee/End Rug, Small Stove / Range
Table, Drop/Occas Sewing Machine Vacuum Cleaner
TV-(19" or less) Table, Child
TV-(20"-40") Vanity
TV-(Over 40") Wardrobe, Small
TV/Snack Trays Wardrobe, Large Other
TV Stand Other
Other
Other
Other
Other

Customer Information

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Address
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New Address Cell Phone
New City New State New Zip
Approx. Move Date Fax Number
Distance in feet from where the truck can park to your front door
Current Home/Apt New Home/Apt
Flight of stairs to current front door (Over 8 Steps)
Current Home/Apt Elevator Available?
Flights of stairs to new front door (Over 8 Steps)
New Home/Apt Elevator Available?
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