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* Name
Current Street Address
City
State
Zip Code
Email Address
* Primary Contact Number
Alternate Contact Number
Best Time to Contact
Moving From
Moving To
Approximate Move Date

LIVING/FAMILY ROOM		QUANTITY
Straight Chair
Arm Chair
Overstuffed Chair
Love Seat
Sofa
Sectional (Each Piece)
Coffee/Sofa Table
End Table
Bookcase Small (3 Shelf)
Bookcase Large (More than 3 Shelves)
Rug
Piano Spinet/Upright
Piano Blackjack/Grand
TV Small (up to 26")
TV Large (over 26")
Trunk
T.V./Stereo Stand
Table Lamp
Floor Lamp

DINING ROOM		QUANTITY
Buffet
Hutch Top
Hutch Bottom
Corner Cabinet
Dining Table
Dining Chair
Server
Rug

KITCHEN		QUANTITY
Breakfast Table
Chair
Cabinet
Trash Can
Bar Stools

APPLIANCES		QUANTITY
Air Conditioner
Dehumidifier
Dishwasher
Refrigerator/Freezer (small under 11 cube)
Refrigerator/Freezer (larger than 11 cube)
Range
Washing Machine
Clothes Dryer
Microwave
Vacuum Cleaner
Portable Heater

BEDROOM		QUANTITY
Bed (Single)
Bed (Double/Full)
Bed (Queen/King)
Bed Bunk
Chair
Bookcase
Armoire
Dresser (single)
Dresser (double)
Dresser (triple)
Night Stand
Rug
Table Lamp
Floor Lamp

OFFICE		QUANTITY
Desk (Small)
Desk (Large)
2 Drawer File Cabinet
4 Drawer File Cabinet
Chair (Small)
Chair (Large)
Bookcase
Table Lamp
Floor Lamp

NURSERY		QUANTITY
Crib
Bassinette
Chest
High Chair
Toy Box
Rocking Chair
Chair

OUTDOOR		QUANTITY
Grill
Deck Chairs
Deck Table
Garden Hose
Trash Can
Garden Tools (set of 5)
Step Ladder
Extension Ladder
Lawn Mower (push)
Lawn Mower (riding)
Cart
Wheelbarrow
Outdoor Gym / Swing Set
Snowblower
Pressure Washer
Gas/Electric Yard Tools

MISCELLANEOUS		QUANTITY
Pool Table
Game Table
Tool Box (portable)
Tool Box (large)
Work Bench
Utility Cabinet
Utility Table
Toys (large not boxed)
Bicycle
Exercise Equipment
Glass Tops
Wall Art/Mirrors

BOXES		QUANTITY
Small (16"x13"x13")
Medium (18"x18"x18")
Large (24"x18"x18")
Extra Large (24"x18"x24")
Dish Carton (18"x18"x24")
Wardrobe Carton
Mirror, Picture, Glass Top Cartons
Flat Screen TV Carton (includes TV) (Size of TV)

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