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Contact Information
First Name
Last Name
Home Phone
Cell Phone
Work Phone
E-mail
Origin Address
Additional Address
Destination Address
Move date
Living Room
Item Name:
QTY:
Item Name:
QTY:
Sofa
Chair
Wall Mirror
Ottoman / Foot Stool
Stereo Cabinet
Area Rug
Love Seat
Futon
Entertainment Center
VCR / DVD
Hall Tree
End Table
Picture
TV Stand
Coffee Table
Marble Top
Sectional Sofa
(# of pieces)
Wall Unit (# of pieces)
Book Case
Reclining Sofa
Lamp
Grandfather Clock
Glass Top
Hide A Bed
TV (less than 25 inches)
TV (25 - 32 inches)
TV (33-40 inces)
TV (more than 40 inches)
Dining Room
Item Name:
QTY:
Item Name:
QTY:
China Cabinet
Dining Table (marble)
Dining Table (wood)
Dining Table (glass)
Dining Chairs
Buffet
Curio Cabinet
Bar Stools
Cutting Board
Etegere / Bakers
Bed Room
Item Name:
QTY:
Item Name:
QTY:
Bed (water)
Bed (Canopy)
Bed (bunk)
Bed (king)
Bed (day)
Bed (queen)
Bed (bridge)
Bed (full)
Bed (caains)
Bed (twin)
Nightstand
Dresser Mirror
Trunk
Vanity
Cedar chest
Dresser
Armoire
Clothes (# of feet)
Chest of Drawers
Nursery
Item Name:
QTY:
Item Name:
QTY:
Crib
Toy chest
Changing Table
Plastic Toys
Bed (toddler)
High chair
Play pen
Office
Item Name:
QTY:
Item Name:
QTY:
Desk (office)
Desk (secretary)
Desk (roll top)
Desk (writing / student)
Copier (large)
Copier (small)
Table (folding)
Table (break room)
Table (computer)
Table (work)
Table (conf.)
File Cabinet (2 drawer)
File cabinet (4 drawer)
File Cabinet (5 drawer)
File cabinet (2 drawer lat)
File Cabinet (4 drawer lat)
File cabinet (5 drawer lat)
File cabinet (fire proof)
Credenza
Chair
Computer & monitor
Stand
Storage cabinet
Safe
Fax
Printer
Appliances
Item Name:
QTY:
Item Name:
QTY:
Refrigerator
Dishwasher
Ironing Board
Freezer
Microwave
Microwave stand
Stove
TV Tray set
Washing machine
Dryer
Vacuum
Patio, Outdoor, Misc.
Item Name:
QTY:
Item Name:
QTY:
BBQ Grill
Fan
Tool chest (small)
Tool chest (large)
Piano (baby grand)
Piano (grand)
Piano (upright)
Piano (spinet)
Mower (riding)
Mower (push)
Aquarium (stand)
Aquarium
Ex Bike
Bicycle
Patio table
Patio chairs
Picnic table
Picnic bench
Plant
Plant stand
Dog house
shelf unit
workout gym
weights (in pounds)
weight bench
treadmill
work bench
ladder
Sewing machine
Bird bath
Glidder / swing
Pool table
Pingpong table
Fire place equipement
Storage containers
Boxes
Item Name:
QTY:
Item Name:
QTY:
Boxes (under 50 lbs)
Boxes (over 50 lbs)
Wardrobes
Dish Pack
Other
Other (please enter comments,
questions, or any items not listed on this form)
