Name

E-mail

Phone

Business Phone

Best Time to Contact*: 

Please Select Any Time Before Noon Before 5pm Between Noon and 5pm Evenings

Moving Date*:

Month January February March April May June July August September October November December

Date 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

Year 2003 2004 2005

Type of Move*:

Please Select Residential Commercial Private House   & Please Select Local Long Distance

Move From

Street Address:

City*:

State/Province*:

Zip/Postal Code:

# of Rooms:

# of Bedrooms:

Extra Pickup Address:(enter city, state/province)

Move To

Street Address:

City*:

State/Province*:

Zip/Postal Code:

Extra Pickup Address:(enter city, state/province)

Items Being Moved

Air Cond/Window

Range -
Electric/Gas

Filing Cabinet
4 dr

Baby Carriage/Stroll

Refrigerator
(1- 6 cu.ft.)

Garden Hose/Tools

BBQ, Grill - Small

Refrigerator
(7-10 cu.ft.)

Golf Clubs

BBQ, Grill - Large

Refrigerator
(11 cu.ft. +)

Ironing Board

Bed - Single

Washer-
Dish/Clothes

Ladder - 6'/Step

Bed - Double

China Barrel

Ladder - 8'/Metal

Bed - Queen

Mirror Ctn
- Small

Ladder - Extension

Bed - King - Bunk

Mirror Ctn
- Large

Grandfather Clock

Bike

Chaise
Lounge

Piano/Organ (under 38'')

Bookcase

Chest
- Bachelor

Piano/Organ (over 38'')

Book Shelves/Sect.

Chest
- Cedar

Piano/Organ (Grand)

Buffet

 Chest
- Toy

Motorcycle

Cabinet - Curio/Utility

Clothes
Hamper

Lamp -Floor/Pole

Cab. - China/Corner

Computer

Lawn Mower

Chair - Arm

Crib - Baby

Magazine Rack

Chair - Child's

Dehumidifier
(Humid.)

Metal Shelves

Chair - Folding

Desk-
Large/Office

Microwave

Chair - High/Straight

Desk -
Secretary

Outdoor Gym/Swing

Chair - Occasional

Desk-Small/Compu ter

Play Pen

Chair - Overstuffed

Dresser
- Double

Rug - Small

Chair - Rocker

Dresser
- Triple

Rug/Pad - Large

Dryer - Electric/Gas

Dresser
- Vanity/Sing.

Sewing
Machine

Freezer (2-10 cu.ft.)

Entertainment
Center

Sofa -
3 Cushions

Freezer (11-15 cu.ft.)

Fan

Sofa/
Love Seat

Freezer (16 cu.ft+)

Filing
Cabinet 2 dr.

Sofa -
Rattan/Wicker

Stool

Stereo

Sofa, Section/per sec.

Table - Card

Swing - Rocker

Bikes

Suitcase

Table - Kitchen

Table - Large

Table - Large

Table - Picnic Table

Night 
Table

Table -Pool/small

Table - Pool/large

Tea Cart

Tool Chest - Small

Tool Chest - Large

Trash Can

TV - Big Screen

TV - Console

TV - Portable

TV - Stand

 Vacuum Cleaner

Wardrobe

Packed Items

Book Box

Medium Box

Linen Box

Packed by owner

Packed by mover

Partial Pack

Storage Needed