Misc.
Qty.
          Boxes LESS Than 50 lbs.

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you except when we have your permission.

First Name

M.I.

Last Name

Address Line

Origin (moving from ?)
City

State

Zip Code

E-mail Address

Phone

Bold Italic = Required field

Destination (moving to ?)
City

State

Zip Code

Loveseat

Piano (down stairs)

Bookcases

Hide-A-Bed

Organ

Recliners, Armchairs,
Rockers

Ottoman/Footstool

Portable TV 13-19in

Television 40+

Coffee or End Table

Stereo Components
(Spkrs, VCR's etc.)

Television 20-29

Television 30-39in

Stereo

TV Stand

Lamps

Spinet Piano

Aquarium 21-40 Gal

Sofa Size Pictures

Pictures & Paintings

Upright Piano

Floor Speakers

Large Screen TV

Aquarium 10-20 Gal

Standing Mirror

Bedroom:
Qty.
           King or Queen Size Bed

Bunk Bed

Head/Footboard

Full Size Bed

Water Bed

Dresser

Armoire / Wardrobe (empty)

Chest of Drawers

Cedar Chest or Trunk

Small Desk

Crib or Changing Table

Twin Size Bed

Bridge Bed

Mirror (Detached)

Nightstand

Linear Feet of Clothes on Rod

Dining Room:
Qty.
           Dining Kitchen Table

China Cabinet (1 or 2 piece)

Dining Chairs or Bar Stools

Kitchen:
Qty.
          Stove or Oven

Buffet or Server

Microwave

Refrigerator or Freezer

Microwave Stand

Washer or Dryer

Butcher Block

Office:
Qty.
           Office or Roll Top Desk

Credenza

Fire Proof File Cabinet

Copier

4 Drawer Lateral File Cabinet

Fireproof Gun Safe

Desk Extension

2 Drawer Filing Cabinet

Conference Table

Computer

Printer Stand

Desk Chair

4 Drawer Filing Cabinet

Drafting Table

2 Drawer Lateral Filing Cabinet

Gun Cabinet

Boxes MORE Than 50 lbs.

Large Plants

Ironing Board or Vacuum

Plant Stand

Iron/Wood Tables

Iron/Wood Chairs

Golf Clubs

Suitcases

Yard Tools

Glass Tops

Marble Tops

Sewing Machine

Bird Bath

Step Ladder

Concrete Bench

Concrete Table

Dorm Fridge

Workbench

Toy Box

Area Rugs

Barbeque or Bicyicle

Extension Ladder

Rolling Tool Chest

Pool Table

Vanity w/Mirror

Riding Mower

Push Mower

Origin:
Important: What is the distance between the front door and where the movers park?
      < 100 ft.

> 100 ft.

Destination:
       < 100 ft.

> 100 ft.

Please mark all that apply:
Origin:
        Elevators

Stairs

# of Flights

Destination:
        Elevators

Stairs

# of Flights

Sectional

Entertainment Center