CUSTOMER INFORMATION:
Customer Name:
Current Address - Street:
City, State, Zip Code:
Final Destination - Street:
City, State, Zip Code:
Estimated date of move:
Home Phone:
Cel Phone:
Work Phone:
E-Mail Address:
Information about your present address:
Where are you moving FROM?
HomeApartmentStorage Unit
What main intersection is this location near?:
Are there stairs:
Yes No
Are there elevators:
Yes No
If so, what floor are you moving FROM?
First Floor Second Floor Third Floor Fourth Floor Above Forth Floor
1st & 2nd floor 2nd & 3rd floor 1st, 2nd & 3rd floor
How far is distance from the parking lot/driveway to the front door?



Information about your final destination address:
Where are you moving To?
Home Apartment Storage Unit
What main intersection is this location near?:
Are there elevators:
Yes No
Are there stairs:
Yes No
If so, what floor are you moving To?
First Floor Second Floor Third Floor Fourth Floor Above Forth Floor
1st & 2nd floor 2nd & 3rd floor 1st, 2nd & 3rd floor
How far is distance from the parking lot/driveway to the front door?


Additional Stops
Will there be any additional stops other than the two above?:
Yes No
If so, what will the stop be for?
HomeApartmentStorage Unit
What main intersection is this location near?:
Are there elevators:
Yes No
Are there stairs/elevators:
Yes No
If so, what floor are you moving FROM?
First Floor Second Floor Third Floor Fourth Floor Above Forth Floor
1st & 2nd floor 2nd & 3rd floor 1st, 2nd & 3rd floor
How far is distance from the parking lot/driveway to the front door?


If there are any items you will need us to move that are not included in the above inventory, please describe the items below.
LIVING ROOM:
Sofa
Loveseat
Sleeper
Bookcase
Coffee Table
End Table
Sofa Table
Etagere
Chair
Ottoman
Rocker
Recliner
Wall Units (Number of pieces)
Stereo (Number of pieces)
Console Stereo
Ent. Cabinet
Pit Group (Number of pieces)
Big Screen TV
Speakers
Flat Panel TV
Console TV
15"-24" Port. TV
25"-36" Port. TV
Do any of the items above have glass or marble?
Yes No
If so, state which pieces.
Will any of the above items need disassembly or assembly?
YesNo
If so, state which pieces.
DEN:
Sofa
Loveseat
Sleeper
Bookcase
Coffee Table
End Table
Sofa Table
Etagere
Chair
Ottoman
Rocker
Recliner
Wall Units (Number of pieces)
Stereo (Number of pieces)
Console Stereo
Ent. Cabinet
Pit Group (Number of pieces)
Big Screen TV
Speakers
Flat Panel TV
Console TV
15"-24" Port. TV
25"-36" Port. TV
Do any of the items above have glass or marble?
Yes No
If so, state which pieces.
Will any of the above items need disassembly or assembly?
YesNo
If so, state which pieces.
DINING/BREAKFAST ROOM
Dining Room Table
Chairs
Buffet
Breakfast Table
Server
Baker's Rack
China Cabinet (2 pc.)
Curio Cabinet (1 pc.)
Do any of the items above have glass or marble?
Yes No
If so, state which pieces.
Will any of the above items need disassembly or assembly?
YesNo
If so, state which pieces.
BEDROOM(S):
Master Bedroom:
King Bed
Queen Bed
Double Bed
Full Bed
Twin Bed
Bunk Bed
Waterbed
Crib
Dresser w/ Mirror
Jewlery Chest
Chester w/o Mirror
Hope Chest
Vanity
Nightstand
Ent. Center
Bookcases
Portable TV
Console TV
Chairs
Stereos
Speakers
Trunk
Armoire
Mirror
Changing Table
Any other items not listed?
Do any of the items above have glass or marble?
Yes No
If so, state which pieces.
Will any of the above items need disassembly or assembly?
YesNo
If so, state which pieces.
Bedroom #1:
King Bed
Queen Bed
Double Bed
Full Bed
Twin Bed
Bunk Bed
Waterbed
Crib
Dresser w/ Mirror
Jewlery Chest
Chester w/o Mirror
Hope Chest
Vanity
Nightstand
Ent. Center
Bookcases
Portable TV
Console TV
Chairs
Stereos
Speakers
Trunk
Armoire
Mirror
Changing Table
Any other items not listed?
Do any of the items above have glass or marble?
Yes No
If so, state which pieces.
Will any of the above items need disassembly or assembly?
YesNo
If so, state which pieces.
Bedroom #2:
King Bed
Queen Bed
Double Bed
Full Bed
Twin Bed
Bunk Bed
Waterbed
Crib
Dresser w/ Mirror
Jewlery Chest
Chester w/o Mirror
Hope Chest
Vanity
Nightstand
Ent. Center
Bookcases
Portable TV
Console TV
Chairs
Stereos
Speakers
Trunk
Armoire
Mirror
Changing Table
Any other items not listed?
Do any of the items above have glass or marble?
Yes No
If so, state which pieces.
Will any of the above items need disassembly or assembly?
YesNo
If so, state which pieces.
Bedroom #3:
King Bed
Queen Bed
Double Bed
Full Bed
Twin Bed
Bunk Bed
Waterbed
Crib
Dresser w/ Mirror
Jewlery Chest
Chester w/o Mirror
Hope Chest
Vanity
Nightstand
Ent. Center
Bookcases
Portable TV
Console TV
Chairs
Stereos
Speakers
Trunk
Armoire
Mirror
Changing Table
Any other items not listed?
Do any of the items above have glass or marble?
Yes No
If so, state which pieces.
Will any of the above items need disassembly or assembly?
YesNo
If so, state which pieces.
Bedroom #4:
King Bed
Queen Bed
Double Bed
Full Bed
Twin Bed
Bunk Bed
Waterbed
Crib
Dresser w/ Mirror
Jewlery Chest
Chester w/o Mirror
Hope Chest
Vanity
Nightstand
Ent. Center
Bookcases
Portable TV
Console TV
Chairs
Stereos
Speakers
Trunk
Armoire
Mirror
Changing Table
Any other items not listed?
Do any of the items above have glass or marble?
Yes No
If so, state which pieces.
Will any of the above items need disassembly or assembly?
YesNo
If so, state which pieces.
OFFICE FURNITURE:
Credenza
Flat Top Desk
L-Shaped Desk
L-Shaped Desk w/hutch
Computer Desk w/hutch
Computer Desk w/o hutch
Chairs
Bookcase(s)
File Cabinet(2 drawer)
File Cabinet(3 drawer)
File Cabinet(4 drawer)
File Cabinet(5 drawer)
Lateral File Cabinet(2 drawer)
Lateral File Cabinet(3 drawer)
Lateral File Cabinet(4 drawer)
Desk Floor Mat(s)
Office Chair
APPLIANCES/MISC. ITEMS:
Washer
Dryer
Stove
Refrigerator
Microwave
Micro Cart
Vacuum
Ironing Board
Stackable Washer/Dryer
Stand-Up Freezer
Chest Freezer
PATIO/RECREATIONAL:
Patio Table
Chairs
Bike
BBQ Pit
Garden Tools
Weight Bench
(lbs. in Wt.)
Exercise Bike
Push Mower
Riding Mower
Trash Cans
Exercise Eq.
Plants(2 to 4ft)
Plants(5 to 7ft)
Treadmill
Elliptical Machine
Tool Box
Stackable Tool Box
Will any of the above items need disassembly or assembly?
YesNo
If so, state which pieces.
MISCELLANEOUS ITEMS:
Spinet Piano
Upright Piano
Baby Grand Piano
Grand Piano
Player Piano
Organ
6ft. Pool Table
8ft. Pool Table
Swing Set
Jungle Jim
Large Toys
Game Table
Video Machine
Jukebox
Ping Pong Table
Air Hockey Table
Foosball Table
BOXES:
One man size(40# or less)
Two man size(40#-60#)
Wardrobe
Dishpack
Misc
If there are any items you will need us to move that are not included in the above inventory, please describe the items below.