CHECKLIST

Name :

E-Mail

Phone :

Alt. Phone :

Fax :

Zip (Orig) :

Address (Destination) :

Address (Origin) :

Approximate Distance (Orig - Dest) In Miles : :

Zip (Dest.)

Anticipated Move Date :

--PLEASE ENTER QUANTITIES IN THE BOXES NEXT TO THE ITEMS BELOW THAT YOU WOULD LIKE FOR US TO MOVE-- LIVING ROOM

Sofa :

Sectional (each piece) :

Entertainment Center(each piece) :

Ottoman, Footstool :

Television 27-36" :

Audio/Video Components :

Loveseat :

Futon :

Bookcase :

Coffee or End Table :

Small TV 8-26" :

Lamp or Picture :

Hide-a-bed :

Keyboard/Stand :

TV Stand :

DINING ROOM

Dining or Kitchen Table :

Buffet or Server :

Dining Chairs or Barstools :

China Cabinet(each piece) :

KITCHEN

Stove or Oven ** :

Microwave :

Refrigerator or Freezer** :

Microwave Stand :

Washer or Dryer** :

BEDROOM

Bed (King or Queen)** :

Bunk Bed** :

Head Board :

Mirror (Detached)** :

Nightstand :

Linear Ft. of Clothes (Hanging) :

Bed (Full)** :

Waterbed** :

Foot Board :

Chest of Drawers :

Trunk or Chest :

Bed (Twin)** :

Trundle Bed** :

Dresser :

Armoire (Empty) :

Crib, Changing Table** :

Small Desk :

OFFICE

Office or Roll-Top Desk :

Credenza :

File Cabinet (Fire Proof) :

Copier :

Computer Components** :

Desk Extension** :

File Cabinet (2 Drawer) :

Conference Table :

Computer Table :

Desk Chair :

File Cabinet (4 Drawer) :

Drafting Table :

Hutch :

MISCELLANEOUS

Boxes Over 50lbs (each) :

Glass Shelves :

Large Plant :

BBQ Grill or Bicycle :

Vanity :

Curio Cabinet :

Boxes Under 50lbs (each) :

Marble Tops :

Small Plant :

Patio Furniture (Each Piece) :

Lawn Mower :

Etagere/Baker's rack :

Glass Tops :

Area Rugs :

Hall Tree :

Ironing Board or Vaccum :

Metal Shelves :

Sewing Machine :

Any Items Not Listed Above (Items listed here will not be reflected in quote price) :

Do you need our movers to disassemble/disconnect and reassemble/reconnect any of the items marked above with ** ? Use the box below to let us know. (There is additional cost for this service that will not be reflected in this quote) :

Do any of these circumstances apply to your move

Stairs at Origin? (enter # of flights) :

Stairs at Destination? (enter # of flights) :

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