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Name:
Home Phone:
Work Phone:
Fax:
E-mail:
When is the best time to contact you?
From To -- hh:mm am/pm
Moving from:
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Does this location have stairs/elevator?
If yes, how many stairs?
Moving to ( at least the city and state):
When is the approximate move date? -- mm/dd/yy Approximately how many rooms with furniture will you be moving? How many bedrooms do you have?
Check off each room that has furniture:
For a more accurate estimate of your move, please include a numbered list of the goods that would be moved. (This is optional but will give us a much better idea of your needs.) i.e. Bed (3), Coffee Table, Love Seat (2), Night Stand, Computer Desk, Stereo with 36" speakers, Computeretc...
Please add any questions or comments in the box below.