Free_form

Please fill in *Required Fields (Red asterisk * )
Incomplete forms will not reach us.

Moving From:

*Name:
Address:
City, State, Zip:
Work Phone:
*Home Phone:
*E-Mail Address:
	# of Flights of Stairs Elevator Yes No
	Preferred Response:
	How Did You Find Us?:

Approximate Moving Date:

Moving To:

Name:
Address:
City, State, Zip:
Work Phone:
Home Phone:
E-Mail Address:
	# of Flights of Stairs Elevator Yes N
	Preferred Response:

*Required Fields

Item	CF	Quantity	Item	CF	Quantity	Item	CF	Quantity
Bar, Portable	15		Fireplace Equipment	5		Sofa, 2 Cushions	35
Bench, Fireside or Piano	5		Foot Stool	2		Sofa, 3 Cushions	50
Bookcase	20		Lamp, Floor or Pole	3		Sofa, 4 Cushions	60
Bookshelves, sectional	5		Magazine Rack	2		Sofa, Sectional, per sect.	30
Chair, Arm	10		Music Cabinet	10		Stereo	20
Chair, Occasional	15		Piano, Baby Gr. or Upr.	70		Stud, Couch and Hideabed	50
Chair, Overstuffed	25		Piano, Parlor Grand	80		Tables, Dropl'f Occas.	12
Chair, Rocker	12		Piano, Spinet	60		Tables, Coffee, End or Nest	5
Chair, Straight	5		Radio, Table	2		Telephone Stand and Chair	5
Clock, Grandfather	20		Record Player Port.	2		Television Combination	25
Day Bed	30		Rugs, Large Roll or Pad	10		Television or Radio Console	15
Desk, Small or Winthrop	22		Rugs, Small Roll or Pad	3		Television Table Model	10
Desk, Secretary	35


Dining Room
Item	CF	Quantity	Item	CF	Quantity	Item	CF	Quantity
Bench, Harvest	10		Chair, Dining	5		Tea Cart	10
Buffet	30		Server	15		Rugs, Large Roll or Pad	10
Cabinet, Corner	20		Table Dining	30		Rugs, Small Roll or Pad	3
Cabinet, China	25


Bedrooms
Item	CF	Quantity	Item	CF	Quantity	Item	CF	Quantity
Bed, Incl. Spring and Mattr.	Please select below		Bureau, Dresser, Chest of Drawers	25		Dresser, Double (Mr. & Mrs.)	50
Bed, Double	60		Cedar Chest	15		Night Table	5
Bed, King Size	70		Chair, Boudoir	10		Rugs, Large Roll or Pad	10
Bed, Single or Hollywood	40		Chair, Straight or Rocker	5		Rugs, Small Roll or Pad	3
Bed, Rollaway	20		Chaise Lounge	25		Vanity Dresser	20
Bed, Bunk (set of 2)	70		Desk, Small or Winthrop	22		Wardrobe, Small	20
Bookshelves	5		Dresser of Vanity Bench	3		Wardrobe, Large	40


Nursery
Item	CF	Quantity	Item	CF	Quantity	Item	CF	Quantity
Bassinette	5		Chest	12		Pen, Play	10
Bed, Youth	30		Chest, Toy	5		Rugs, Large Roll or Pad	10
Chair, Childs	3		Crib, Baby	10		Rugs, Small Roll or Pad	3
Chair, High	5		Table, Child	5


Kitchen
Item	CF	Quantity	Item	CF	Quantity	Item	CF	Quantity
Breakfast, Suite Chairs	5		Kitchen Cabinet	30		Table	5
Breakfast Table	10		Roaster	5		Utility Cabinet	10
Chair, High	5		Serving cart	15		Vegetable Bin	3
Ironing Board	2		Stool	3


Appliances
Item	CF	Quantity	Item	CF	Quantity	Item	CF	Quantity
Air Conditioner	30		Ironer or Mangle	12
Dehumidifier	10		Range, Electric or Gas	30
Dishwasher	20		Refrigerator,	Please select below
Dryer, Electric or Gas	25		6 Cubic Feet or less	30
Freezer, Cu. Capacity	Please select below		7 to 10 Cubic Feet	45
10 Cubic Feet or less	30		11 Cubic Feet or More	60
11 to 15 Cubic Feet	45		Vacuum Cleaner	5
16 Cubic Feet and Up	60		Washing Machine	25


Porch, Outdoor Furniture and Equipment
Item	CF	Quantity	Item	CF	Quantity	Item	CF	Quantity
Barbecue or Port. Grill	10		Lawn Mower, Power	15		Rocker, Swing	15
Bath, Bird	5		Lawn Mower, Riding	35		Roller, Lawn	15
Chairs, Lawn	5		Leaf Sweeper	5		Rug, Large	7
Chairs, Porch	10		Outdoor Childs Slide	10		Rug, Small	3
Clothes, Line	5		Outdoor Childs Gym	20		Sand Box	10
Clothes, Dryer Rack	5		Outdoor Drying Racks	5		Settee	20
Garden Hose and Tools	10		Outdoor Swings	30		Spreader	1
Glider or Settee	20		Picnic Table	20		Table	10
Ladder, Extension	10		Picnic Bench	5		Umbrella	5
Lawn Mower, Hand	5		Porch Chair	10		Wheel Barrow	8


Miscellaneous
Item	CF	Quantity	Item	CF	Quantity	Item	CF	Quantity
Ash or Trash Can	7		Fan	5		Sewing Machine	10
Basket (Clothes)	5		Fernery or Plant Stands	10		Sled	2
Bicycle	10		Foot Lockers	5		Step Ladder	5
Bird Cage and Stand	5		Garbage Cans	7		Suitcase	5
Card Table	1		Golf Bag	2		Table, Utility	5
Cabinet, Filing	20		Heater, Gas or Electric	5		Tackle Box	1
Carriage, Baby	20		Incinerator	10		Tool Chest	10
Chairs, Folding	1		Metal Shelves	5		Tricycle	5
Clothes, Hamper	5		Ping Pong Table	20		Wagon, Child's	5
Cot, Folding	10		Pool Table	40		Waste Paper Basket	2
Desk, Office	30		Power Tools	20		Work Bench	20


Boxes
Small	1.5		Large	6		Picture	5
Medium	3		Wardrobe	15		Dishpak	10

Comments

1.		= Total Cubic Feet = Total Weight
2.
3.