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Denotes a required Field
Contacat Information
Pick UP
Drop Off
*
Name
*
Pick Up Zip Code
*
Drop Off Zip Code
*
Phone 1
Elevator
YES
Elevator
YES
Phone 2
OR
OR
*
Email
Flights of Stairs
0
1
2
3
4
5
6
Flights of Stairs
0
1
2
3
4
5
6
*
Move Date
Month
Jan
Feb
March
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Walking distance (ft.)
1 to 99
100 to 149
150 to 199
200 to 249
250 to 299
300 to 349
350 to 399
400 to 449
550 to 599
600 to 649
650 to 699
Walking distance(ft.)
1 to 99
100 to 149
150 to 199
200 to 249
250 to 299
300 to 349
350 to 399
400 to 449
550 to 599
600 to 649
650 to 699
*
Please enter one way milage between
Pick Up
and
Drop Off
.
(Numbers Only)
>>>
Living Room / Hall
Sofa or Futon
Love Seat or Sec. Sofa (#of pieces)
Sleeper or Recliner Sofa
Chase Lounge
Recliner or Large Chair
Ottoman
Armoire or Entertainment Ctr (lg)
Entertainment Center (small)
End Table
Coffee or Sofa or Entry Table
TV Stand
TV - 30" or Less
TV - 31" to 40"
TV - 41" - 59"
TV - 60' or Larger
DVD or Stereo or Speakers (sm)
Speakers (large)
Fireplace Screen or Tools
Hall Tree or Coat Rack
Grandfather Clock
Curio Cabinet (regular)
Curio Cabinet (large)
Piano (upright) or Organ
Piano (grand)
Dinning Room
Dining Table or Kitchen Table
Dining Chairs or Bar Stools
Buffet or Bakers Rack
China Cabinet (1 or 2 pieces)
Table Leaf
Dinning Room (Cont.)
Microwave
Server or Microwave Cart
Refrigerator or
Freezer
No Svc
Discon
Recon
Both
Washer or
Dryer
No Svc
Discon
Recon
Both
Stove or Dishwasher
Bedroom / Nursery
King Bed
Service
0
1
2
3
4
5
6
Queen
Service
0
1
2
3
4
5
6
Full Bed
Service
0
1
2
3
4
5
6
Twin Bed
Service
0
1
2
3
4
5
6
Headboard or Foot Board
Water Bed or Bridge Bed (Pcs)
Service
0
1
2
3
4
5
6
Trundle Bed or Bunk Bed
Service
0
1
2
3
4
5
6
Baby Bed
Service
0
1
2
3
4
5
6
Armoire
Dresser or Chest of Drawers
Night Stand
Cedar Chest or Trunk
Clothing (# of linear feet)
Office
Office Desk
Roll Top Desk
Credenza
Small Desk or Printer Stand
Desk Hutch (small)
Desk Hutch (large)
Desk Return
Desk Extension
Desk Chair or Side Chair
Office (Cont.)
Desk Matt or Dry Eraser Board
Book Case (small)
Bookcase (large)
2-Drawer File Cabinet (standard)
4-Drawer File Cabinet (standard)
2-Drawer File Cabinet (lateral)
4-Drawer File Cabinet (lateral)
Copier or Printer (small)
Copier orPrinter (large)
Computer Monitor or CPU
(# of pcs)
Garage Outside
Lawn Mower or Edger
Trimmer or Blower
Ladder or Wheel Barrow
Grill or Bike
Storage Cabinet / Metal Shelf (small)
Storage Cabinet / Metal Shelf (lg)
Patio Table
Patio Chairs
Miscellaneous
Small or Med. Box (40 lbs. or less)
Large Box (up to 80 lbs.)
Wardrobe or Extra Large Box
Picture/Mirror/Glass/Marble (small)
Picture/Mirror/Glass/Marble (large)
Plant or Tree (sm)
Plant or Tree (lg)
Rug (small-med)
Rug (large)
Lamp (without lamp shade)
Bench
Additional Comments
