Contact Information

Name:

Email:

Home Phone:

Work Phone:

Fax:

Estimated move date: / /

Moving from

Address:

City:

State:

Size of residence:

Number of bedrooms:

Number of rooms:

Flight of stairs:

Moving to:

Address:

City:

State:

Size of residence:

Number of bedrooms:

Number of rooms:

Flight of stairs:

How many major appliances:

Living room

Arm chair: End table:

Sofa: TV:

Love seat: Stand:

Rocking chair: Futon:

Lamp: Entertainment:

Piano: Ottomon:

Rugs: Coffee table:

Stereo:

Office

Desk: File Cabinet:

Picnic Table: Fan:

Book case: Grill:

Suitcase: Work bench:

Computer: Exercise Equip:

Trunk:

Boxes

Small: Medium:

Large: Wardrobe:

Picture Frame:

Dining room

China cabinet: Buffet:

Chair: Table:

Tea Chart: Hutch:

Kitchen

Refrigerator: Freezer:

Dryer: Washer:

Table: Chairs:

Cabinet: Vacuum:

Microwave: A/C:

Bedroom

Double Bed: Queen Bed:

King Bed: Twin Bed:

Bureau: Chest:

Dresser: Night table:

Armoire: Mirror: