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Type of move: |
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Type of service: |
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Size of current residence?: |
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Are you interested in
our packing services?: |
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When would you like
to move?: |
22.02.2012 
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Preferred time?: |
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How did you hear
about us?: |
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Your name (first and
last): |
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Email Address: |
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Confirm Email Address: |
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Phone Number (and ext.
if necessary): |
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Where Are You Moving
FROM?: |
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Street Address (include unit
#): |
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City: |
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State: |
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Type of residence: |
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What floor?: |
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Where should we park
our truck?: |
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How close can we
park our truck: |
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Is there any elevator?: |
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Please inventory the items you plan on moving. The more details you can give us about your stuff, the more accurate your estimate will be. |
Bedroom QTY (if 0 or none, leave as default option) |
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Full/twin mattress: |
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Full/twin box spring: |
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Queen mattress: |
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Queen box spring: |
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King mattress: |
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King box spring: |
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Head/footboard: |
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Bedframe: |
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Futon: |
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Dresser (small): |
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Dresser (large): |
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Chest: |
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Nightstand: |
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Crib: |
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Armoire: |
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Suitcase: |
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Exceptionally Large Items QTY (if 0 or none, leave as default option)
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Refrigerator (mini-size): |
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Refrigerator (full-size): |
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Freezer: |
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Dishwasher: |
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Stove: |
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Washing machine: |
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Dryer: |
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Treadmill / exercise machine: |
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Safe: |
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Large sculpture: |
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Kitchen and Dining Area QTY (if 0 or none, leave as default option)
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Dining room table: |
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Dining room chair: |
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Wine rack: |
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Buffet: |
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China cabinet: |
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Microwave: |
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Butcher block / island: |
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Shelf: |
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Movable bar: |
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Bar stool: |
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Miscellaneous Items QTY (if 0 or none, leave as default option)
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Desk (small): |
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Desk (medium): |
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Desk (large): |
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File cabinet: |
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Plant (small): |
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Plant (large): |
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Rug (small): |
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Rug (large): |
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Framed poster / artwork: |
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Framed mirror: |
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Floor mirror: |
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Floor lamp: |
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Table lamp: |
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Air conditioner: |
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Bicycle: |
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Grill: |
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Patio / outdoor table: |
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Outdoor chair: |
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Living Room QTY (if 0 or none, leave as default option)
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Couch (3-seater): |
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Couch (loveseat): |
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Couch (sectional): |
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Couch (sleeper sofa): |
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Recliner / sofa chair: |
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Ottoman: |
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Coffee table: |
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End table: |
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TV (large flat screen): |
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TV (small flat screen): |
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TV (large tube): |
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TV (small tube): |
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TV Stand: |
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Entertainment center: |
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Stereo: |
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Large speaker: |
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Bookshelf / other shelving: |
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Boxes and Containers
Please estimate the number of boxes (or containers) to be moved. This is very important! |
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Small boxes: |
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Medium boxes: |
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Large boxes: |
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Furniture Disassembly:
Do you need help disassembling furniture? (ex: entertainment centers, beds, cribs, stuff from Ikea, etc.) |
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Please check box if yes..: |
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Additional items, special notes or other locations:
Please list any items that are missing from above.
If you have additional pick-up / drop-off locations, please let us know.
Also, if you have any further comments or questions, ask them here |
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Comments: |
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