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Please fill out all fields so we may give you the most accurate estimate for your move.
* Required Fields
First Name
*
Last Name
*
Cell Phone
*
[222-2222 or 222-222-2222]
Home Phone
[222-2222 or 222-222-2222]
Work Phone
[222-2222 or 222-222-2222]
E-Mail Address
*
Alternate Contact Name
Alternate Contact Phone
[222-2222 or 222-222-2222]
Payment Method
--
Cash
Local Check
Certified Check
Visa
MasterCard
Discover
American Express
Local moves can be paid with cash, local check, certified check, or credit card. Long-Distance moves can be paid with cash, certified check, or credit card.
Projected Move Date
--
January
February
March
April
May
June
July
August
September
October
November
December
/
--
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
/
--
2008
2009
2010
2011
2012
Alternate Move Date
--
January
February
March
April
May
June
July
August
September
October
November
December
/
--
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
/
--
2008
2009
2010
2011
2012
Multiple Long-Distance Move Days
Type of Move
--
Home
Apartment
Storage
Portable Storage
Rental Truck
Internal
Business
Move-Out Information
Address
*
Apartment Number
City
*
State
*
Zip Code
*
Apt. Complex/Subdivision
Building Number
Gate Code
Storage Number
Estimated Square Footage Of Site
How Many Levels In Unit?
Is There An Elevator?
--
No
Yes
Number Of Floors
Estimated Walk Distance From Load-Out Door To Truck In Feet
Number Of Steps
Is It Flat Where The Truck Parks?
--
Flat
Slope Up
Slope Down
Steep Slope
Narrow Drive
Sharp Turns
Overhead Obstructions
Are there any trees or utility lines where the truck parks?
Years in house?
2nd Load Address (If Needed)
Move-In Information
Address
Apartment Number
City
State
Zip Code
Apt. Complex/Subdivision
Building Number
Gate Code
Storage Number
Estimated Square Footage Of Site
How Many Levels In Unit?
Is There An Elevator?
--
No
Yes
Number Of Floors
Estimated Walk Distance From Truck To Load-In Door In Feet
Number Of Steps
Is It Flat Where The Truck Parks?
--
Flat
Slope Up
Slope Down
Steep Slope
Narrow Drive
Sharp Turns
Overhead Obstructions
Are there any trees or utility lines where the truck parks?
2nd Un-Load Address (If Needed)
Is this a point "A" to point "B" move or multiple stops?
--
A to B
1 Extra Stop
2 Extra Stops
3 Extra Stops
4+ Extra Stops
Approximate distance between two move locations in miles?
Do you want the movers to pack?
--
Yes
No
Do you want the movers to unpack?
--
Yes
No
Do you want the movers to deliver boxes?
--
Yes
No
See
box inventory
(opens in a new window) for cost
Home Inventory
Please take the time to fill out the inventory section in full so we may determine your moving needs.
Kitchen:
table
0
1
2
3
4
5
6
7
8
9
10
11
12
chairs
0
1
2
3
4
5
6
7
8
9
10
11
12
baker's rack
0
1
2
3
4
5
6
7
8
9
10
11
12
refrigerator
0
1
2
3
4
5
6
7
8
9
10
11
12
microwave
0
1
2
3
4
5
6
7
8
9
10
11
12
washer
0
1
2
3
4
5
6
7
8
9
10
11
12
dryer
0
1
2
3
4
5
6
7
8
9
10
11
12
wine rack/bar
0
1
2
3
4
5
6
7
8
9
10
11
12
cabinet/island
0
1
2
3
4
5
6
7
8
9
10
11
12
bar stools
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Dining Room:
table
0
1
2
3
4
5
6
7
8
9
10
11
12
chairs
0
1
2
3
4
5
6
7
8
9
10
11
12
china cabinet
0
1
2
3
4
5
6
7
8
9
10
11
12
buffet
0
1
2
3
4
5
6
7
8
9
10
11
12
curio
0
1
2
3
4
5
6
7
8
9
10
11
12
hutch
0
1
2
3
4
5
6
7
8
9
10
11
12
floor lamps (whole house)
table lamps (whole house)
large pictures (whole house)
rugs (whole house)
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Foyer:
tables
0
1
2
3
4
5
6
7
8
9
10
11
12
chairs
0
1
2
3
4
5
6
7
8
9
10
11
12
spinet piano
0
1
2
3
4
5
6
7
8
9
10
11
12
chest
0
1
2
3
4
5
6
7
8
9
10
11
12
trunk
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Living Room:
sofa
0
1
2
3
4
5
6
7
8
9
10
11
12
sleeper sofa
0
1
2
3
4
5
6
7
8
9
10
11
12
sectional sofa
0
1
2
3
4
5
6
7
8
9
10
11
12
love seat
0
1
2
3
4
5
6
7
8
9
10
11
12
chairs
0
1
2
3
4
5
6
7
8
9
10
11
12
ottoman
0
1
2
3
4
5
6
7
8
9
10
11
12
armoire
0
1
2
3
4
5
6
7
8
9
10
11
12
coffee table
0
1
2
3
4
5
6
7
8
9
10
11
12
end tables
0
1
2
3
4
5
6
7
8
9
10
11
12
TV
0
13"-41"
42"+ ($50 Charge)
sofa table
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Den:
sofa
0
1
2
3
4
5
6
7
8
9
10
11
12
love seat
0
1
2
3
4
5
6
7
8
9
10
11
12
chairs
0
1
2
3
4
5
6
7
8
9
10
11
12
tables
0
1
2
3
4
5
6
7
8
9
10
11
12
coffee table
0
1
2
3
4
5
6
7
8
9
10
11
12
end tables
0
1
2
3
4
5
6
7
8
9
10
11
12
entertainment center
0
1
2
3
4
5
6
7
8
9
10
11
12
armoire
0
1
2
3
4
5
6
7
8
9
10
11
12
desk
0
1
2
3
4
5
6
7
8
9
10
11
12
TV
0
13"-41"
42"+ ($50 Charge)
stereo equipment
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Master Bedroom:
bed
0
King
Queen
Full
Twin
Bunk Beds
Trundle Bed
Futon
dresser
0
1
2
3
4
5
6
7
8
9
10
11
12
armoir/wardrobe
0
1
2
3
4
5
6
7
8
9
10
11
12
chest of drawers
0
1
2
3
4
5
6
7
8
9
10
11
12
night stands
0
1
2
3
4
5
6
7
8
9
10
11
12
desk
0
1
2
3
4
5
6
7
8
9
10
11
12
chair
0
1
2
3
4
5
6
7
8
9
10
11
12
total mirrors in house not attached to dressers
0
1
2
3
4
5
6
7
8
9
10
11
12
TV
0
13"-41"
42"+ ($50 Charge)
TV stand
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
2nd Bedroom:
bed
0
King
Queen
Full
Twin
Bunk Beds
Trundle Bed
Futon
dresser
0
1
2
3
4
5
6
7
8
9
10
11
12
sewing machine (whole house)
0
1
2
3
4
5
6
7
8
9
10
11
12
chest of drawers
0
1
2
3
4
5
6
7
8
9
10
11
12
night stands
0
1
2
3
4
5
6
7
8
9
10
11
12
desk
0
1
2
3
4
5
6
7
8
9
10
11
12
chair
0
1
2
3
4
5
6
7
8
9
10
11
12
mirror
0
1
2
3
4
5
6
7
8
9
10
11
12
TV
0
13"-41"
42"+ ($50 Charge)
TV stand
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
3rd Bedroom:
bed
0
King
Queen
Full
Twin
Bunk Beds
Trundle Bed
Futon
dresser
0
1
2
3
4
5
6
7
8
9
10
11
12
crib
0
1
2
3
4
5
6
7
8
9
10
11
12
chest of drawers
0
1
2
3
4
5
6
7
8
9
10
11
12
night stands
0
1
2
3
4
5
6
7
8
9
10
11
12
desk
0
1
2
3
4
5
6
7
8
9
10
11
12
chair
0
1
2
3
4
5
6
7
8
9
10
11
12
bookcase
0
1
2
3
4
5
6
7
8
9
10
11
12
TV
0
13"-41"
42"+ ($50 Charge)
TV stand
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
4th Bedroom:
bed
0
King
Queen
Full
Twin
Bunk Beds
Trundle Bed
Futon
dresser
0
1
2
3
4
5
6
7
8
9
10
11
12
futon
0
1
2
3
4
5
6
7
8
9
10
11
12
chest of drawers
0
1
2
3
4
5
6
7
8
9
10
11
12
night stands
0
1
2
3
4
5
6
7
8
9
10
11
12
desk
0
1
2
3
4
5
6
7
8
9
10
11
12
chair
0
1
2
3
4
5
6
7
8
9
10
11
12
mirror
0
1
2
3
4
5
6
7
8
9
10
11
12
TV
0
13"-41"
42"+ ($50 Charge)
TV stand
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Office:
desk
0
1
2
3
4
5
6
7
8
9
10
11
12
chairs
0
1
2
3
4
5
6
7
8
9
10
11
12
credenza
0
1
2
3
4
5
6
7
8
9
10
11
12
bookcases
0
1
2
3
4
5
6
7
8
9
10
11
12
verticle file cab.
0
1
2
3
4
5
6
7
8
9
10
11
12
lateral file cab.
0
1
2
3
4
5
6
7
8
9
10
11
12
computer
0
1
2
3
4
5
6
7
8
9
10
11
12
printer/fax
0
1
2
3
4
5
6
7
8
9
10
11
12
table
0
1
2
3
4
5
6
7
8
9
10
11
12
plants (whole house)
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Basement:
sofa
0
1
2
3
4
5
6
7
8
9
10
11
12
loveseat
0
1
2
3
4
5
6
7
8
9
10
11
12
chairs
0
1
2
3
4
5
6
7
8
9
10
11
12
entertainment center
0
1
2
3
4
5
6
7
8
9
10
11
12
tools/toolbox
0
1
2
3
4
5
6
7
8
9
10
11
12
treadmill
0
1
2
3
4
5
6
7
8
9
10
11
12
exercise bike
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Garage:
mower
0
1
2
3
4
5
6
7
8
9
10
11
12
blower
0
1
2
3
4
5
6
7
8
9
10
11
12
weed eater
0
1
2
3
4
5
6
7
8
9
10
11
12
refridgerator
0
1
2
3
4
5
6
7
8
9
10
11
12
deep freeze
0
1
2
3
4
5
6
7
8
9
10
11
12
shelves
0
1
2
3
4
5
6
7
8
9
10
11
12
ladders
0
1
2
3
4
5
6
7
8
9
10
11
12
tool box
0
1
2
3
4
5
6
7
8
9
10
11
12
bicycles
0
1
2
3
4
5
6
7
8
9
10
11
12
cabinets
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Attic:
Christmas tree
0
1
2
3
4
5
6
7
8
9
10
11
12
furniture
0
1
2
3
4
5
6
7
8
9
10
11
12
boxes
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Outdoors:
grill
0
1
2
3
4
5
6
7
8
9
10
11
12
outdoor chairs
0
1
2
3
4
5
6
7
8
9
10
11
12
swing
0
1
2
3
4
5
6
7
8
9
10
11
12
outdoor table
0
1
2
3
4
5
6
7
8
9
10
11
12
planters (whole house)
0
1
2
3
4
5
6
7
8
9
10
11
12
please list any other items
Special Handling:
(may require extra charge)
baby grand piano
0
1 - $100
upright piano (42"+)
0
1 - $50
pool table
0
1 - $100
security safe or gun safe
0
1 - $50
fire-proof file cabinet
0
1 - $50
large screen TV (42" and up)
0
1 - $50
2 - $100
3 - $150
4 - $200
5 - $250
grandfather clock
0
1 - $50
riding mower
0
1
2
3
4
5
6
7
8
9
10
11
12
commercial appliance (ex. Sub Zero Fridge)
0
1
2
3
4
5
6
7
8
9
10
11
12
Big Green Egg (smoker)
0
1
2
3
4
5
6
7
8
9
10
11
12
Do you have any other items that require special handling?
What are the declared values for the additional special handling items?
How many boxes in the whole house?
If you have anything we may have forgotton, like a room (5th bedroom, bonus room, sunroom, etc.), a piece of furniture, or anything else, please list it below.
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