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Personal Information

* First Name:

* Last Name:

* Home / Cell Phone:

Work Phone:

* Email:

* Contact Preference:

Home or Cell Phone Work Phone

Moving From

Moving To

* City:

* City:

* State:

* State:

* Zip:

* Zip:

Moving Type

Approx. Moving Date:

Within 2 weeks Within 1 month Within 2 months More than 2 months

* Moving Size:

Partial home Studio 1 small bedroom 1 large bedroom 2 bedroom 3 bedroom 4 bedroom More than 4 bedrooms Small office Large office Automobile

Additional Comments:

Living Room

Bedroom

Porch & Outdoor

Bar, portable

Bed Incl Sp/Mattress

BBQ Grill, Small

Bench, Frsd/Piano

Bed Rollaway

BBQ Grill, Large

Bookcase

Bed, Single/Hollywood

Chairs, Aluminum

Bookshelves, Sect

Bed, Std/Double

Chairs, Metal

Cabinet, Curio

Bed, Queen

Chairs, Wood

Chair, Straight

Bed, King

Garden Hose & Tools

Chair, Arm

Bed, Bunk (Set 2)

Glider or Settee

Chair, Rocker

Bookshelves, Sec

Ladder, 6' Step

Chair, Occasional

Chair, Boudoir

Ladder 8' Metal

Chair, Overstuffed

Chair, Rocker

Ladder, Extension

Chest, Cedar

Chaise Lounge

Lawn Mower, Hand

Clock, Grandfather

Chest, Bachelor

Lawn Mower, Power

Day Bed

Chest, Cedar

Lawn Mower, Riding (HP)

Desk, Small

Chest, Armoire

Lawn Edger

Desk, Secretary

Desk, Small

Leaf Sweeper

Fireplace Equip.

Dresser, Vanity

Outdoor Child Slide

Footstool

Dresser, Single

Outdoor Child Gym

Hall Tree Rack

Dresser, Double

Outdoor Drying Racks

Hall Tree Large

Dresser, Triple

Outdoor Swings

Lamp, Floor

Exercise Bike

Picnic Table

Lamp, Pole

Lamp, Floor

Picnic Bench

Magazine Rack

Night Table

Roller, Lawn

Music Cabinet

Rug, Large or Pad

Rug, Large

Piano, Baby Grand/Upr

Rug, Small or Pad

Rug, Small

Piano, Parlor Grand

Wardrobe, Small

Sandbox

Radio, Table

Wardrobe, Large

Table, Small

Record Player, Portable

Waterbed

Table, Large

Rugs, Large Roll/Pad

Nursery

Umbrella

Rugs, Small Roll/Pad

Bathinette

Wheelbarrow

Sofa, Rattan/Wicker

Bed, Youth

Misc.

Sofa, Sec., Per Sec

Chair, Childs

Baby Carriage

Sofa, Loveseat

Chair, High

Barbells, Per Pound

Sofa, 3 Cushion

Chest

Basket, Clothes

Sofa, Hideaway, 4 Cushion

Chest, Toy

Bicycle

Stereo Component

Crib, Baby

Tricycle

Stereo, Console

Table, Childs

Bowling Ball/Bag

Tables, Dropl/Occas

Playpen

Card Table

Tables, Coffee

Rug, Large or Pad

Folding Chairs

Tables, End

Rug, Small or Pad

Clothes Hamper

Telephone Stand

Appliances

Cot, Folding

TV, Bigscreen

Air Cond/Wind. Sm.

Desk, Office

TV, Portable

Air Cond/Wind. Large

Fan

TV, Console

Dehumidifier

Fern/Plant Stands

TV, Combination

Dishwasher

Filing Cabinet, Cardboard

TV, Stand

Freezer

Filing Cabinet, 2 door

Trunk

Freezer 10 or Less

Filing Cabinet, 4 door

Dining Room

Freezer 11 to 15

Footlockers

Bench, Harvest

Freezer 10 or Over

Game Table

Buffet (Base)

Range 20" Wide

Golf Bag

Hutch (Top)

Range 30" Wide

Heater, Gas/Electric

Cabinet, Corner

Range 36" Wide

Metal Shelves

Dining Table

Refrigerator (CuCp)

Ping Pong Table

Dining Chair

Refr. 6 cu ft. or Less

Pool Table Comp.

Server

Refr. 7 to 10 cu ft.

Pool Table Slate

Tea Cart

Refr. 11 cu ft or Over

Power Tool, Hand ea.

Rugs, Large or Pad

Trash Compactor

Power Tool Stand

Rugs, Large or Small

Vacuum Cleaner

Sewing Machine, Console

Additional Boxes

Washing Machine

Sewing Machine, w/Cabinet

Please fill in the quantity of boxes that are to be included in the move.

Dryer

Sled

Small Boxes

Kitchen

Suitcase

Medium Boxes

Bkft. Suite, Chairs

Table, Utility

Large Boxes

Breakfast Table

Tackle Box

Chair, High

Tire

Ironing Board

Tire w/Rim

Kitchen Cabinet

Toolchest, Small

Microwave Oven

Toolchest, Large

Serving Cart

Trash Can

Stool

Wagon, Child's

Table

Wastepaper Basket

Utility Cabinet

Work Bench

Personal Computer

Monitor

Printer