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Personal Information

Name: Email: Home Phone: Work Phone: Cell Phone: Best Time To Call: Any Time Weekday 8AM-12PM Weekday 12PM-5PM Weekday 5PM-8PM Weekend 8AM-12PM Weekend 12PM-5PM Weekend 5PM-8PM

Moving Information

What is Your Current Address? What is Your Destination Address? Street: City: State: Current State Alaska Alabama Arkansas Arizona California Colorado Connecticut Washington D.C. Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missourri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip Code: What Type of Home? Private House Apartment Is there an elevator? Yes No Street: City: State: Destination State Alaska Alabama Arkansas Arizona California Colorado Connecticut Washington D.C. Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missourri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip Code: What Type of Home? Private House Apartment Is there an elevator? Yes No How Many Full Rooms of Furniture are You Moving? How Many Boxes Are You Planning on Moving? Do You Plan On Packing Yourself? Yes No When Do You Plan On Moving? /  / (MM/DD/YY) Do You Need Storage? Yes No (if yes, for how long )

Insert the number of items you will be moving in the white boxes next to the items

Living Room: Bar portable Entertainment center, lg Tables, coffee Bookcase Lamps Tables, end Cabinet Rugs small TV, up to 30" Chair Rugs large TV, larger than 30" Chair, arm Sofa, love seat VCR Chair, rocker Sofa, sectional Pictures Chair, overstuffed Sofa, large Clock, grandfather Entertainment center, med Stereo Piano None Spinet Upright Piano Baby Grand Grand Dining Room: Buffet (base) Dining table Rug (small) Hutch (top) Dining Chairs Rug (large) Cabinet, corner Pictures Bedrooms: Bed, single Chair Night table Bed, double Chest, armoire Pictures Bed, queen Bookshelves (sectional) Lamps_bedroom Bed, king Dresser, single Rug_bedroom Bed, bunk Dresser, double Rug (large) Head or Foot Board Dresser, triple TV Nursery: Bed, youth Change-table Table, child's Chest, toy Crib, baby Rocking Chair Appliances: Air-condition/window.sm Freezer 10-15 Washing machine Air-condition/window.lg Freezer 16 or over Refrigerator (6 cu. ft. or less) Dishwasher Dryer Refrigerator (7-10 cu. ft.) Freezer 10 cf or or less Vacuum cleaner Refrigerator (11 cu. ft. or over) Kitchen: Chairs Ironing board Microwave oven Breakfast table Microwave cart Porch & Outdoor: BBQ grill, small Swing set Lounge chairs BBQ grill, large Outdoor gym Picnic table Chairs, aluminum Chairs, metal Umbrella Miscellaneous: Bicycle Floor safe lbs. Fine Art Desk, office Toolchest  Musical instruments Filing cab. 2 door Exercise equipment Trash can Filing cab. 4 door Computers Treadmill Boxes: Estimated number of boxes needed Wardrobe Mattress box Mirror-pack Large Carton File Wood crate Medium Carton China Book

Extra size items: Comments: