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Please fill in your contact information below

*Your Name:

*Origin Address:

*Destination Address:

E-mail Address:

*Home Phone:

*Work Phone:

*Cellular Phone:

Alternate Phone:

*Move Date:

Please fill in the amount of each item in the QTY Column



	QTY	C/F	Total		QTY	C/F	Total
	Appliances
AIR COND/WINDOW		20		Microwave Stand		15
AiR COND/Sm		10		Refrigerator Lg		60
Dishwasher		20		Refrigerator Md		45
Dryer		25		Refrigerator Sm		30
Freezer Lg		60		Sewing Machine Cabinet		10
Freezer Md		45		Sewing Machine Portable		5
Freezer Sm		15		Trash Compactor		10
Microwave Oven		5		Washing Machine		25
Shop Vac		5		Stackable Washer/Dryer		35
Vacuum Cleaner		5		Dehumidifier		5


	Bedroom
Bunk Bed		70		Waterbed Base		10
Day Bed / Captain		50		Full Bed		60
King Bed		80		Foot/Head Board		10
Queen Bed		70		Single Dresser		30
Rollaway Bed		20		Double Dresser		40
Single Bed		40		Triple Dresser		50
Twin Bed		60		Vanity Dresser		20
Futon Lamp		70		Vanity Bench/dresser		3
Night Stand		5		Chaise Lounge		25
Trunk		10		Cedar Chest		10
Wardrobe Lg		40		Foot Locker/Batchelor Chest		8
Wardrobe Sm		20		Chest of Drawers		3


	Dining Room
Harvest Bench		25		Dining Table		30
Buffet Base		50		Dining Chairs		5
Corner Cabinet		40		Hutch		3
China Cabinet		40		Bakers Rack		5
Microwave Stand		40		Tea Cart		1


	Nursery
Baby Carriage		2		Changing Table		25
Bassinet		15		High Chair		35
Childs Chair		15		Baby Crib		10
Toy Chest		2		Playpen		8


	Living Room
Arm Chair		10		Sofa 2 Cushion /Love Seat		35
Armoire Lg		40		Sofa 3 Cushion		50
Armoire Sm		20		Sofa 4 Cushion		60
Portable Bar		15		Sofa Sectional Pieces		30
Piano Bench		5		Floor Speaker		5
Grand Piano Parlor		80		Shelf Speaker		1
Piano Spinet/Console		60		Stereo Component		3
Room Divider		10		Occasional Chair		15
Rug Lg Roll/Pad		10		Overstuffed Chair		25
Rug Sm Roll /Pad		3		Recliner/Lazy Boy		25
Book Shelf Lg		40		Rocking Chair		12
Book Shelf Sm		20		Straight Chair		5
DVD/VCR		3		Grandfather Clock		15
Foot Stool/ Ottoman		2		Desk Large		35
Magazine Rack		2		Entertainment Center Lg		80
Arm Table		5		Entertainment Center Sm		50
Coffee Table/end Table		5		Fireplace Equipment		5
TV Console (20" - 30")		15		TV Portable		5
TV Stand		10		TV Combo		15
TV Big Screen		40		Room Divider		10


	Misc/ Outdoor
Basket Clothes		5		Outdoor Gas Heater		7
Clothes Hamper		5		Lawn Mower Hand		5
BBQ Grill Large		10		Lawn Mower Power		15
BBQ grill small		5		Lawn Mower Ride		35
Bike		7		Leaf Blower		5
Chair Lawn/Metal		3		Outdoor Swings		30
Chair Aluminum		3		Picnic Bench		7
Chair Wood		3		Picnic Table		20
Treadmill		25		Ping Pong Table		30
Exercise Bicycle		5		Pool Table		40
Golf Club Bag		2		Tool Chest Lg		15
Ladder Small/Kitchen		3		Tool Chest Md		10
Ladder Medium		4		Tool Chest on Wheels		10
Ladder Large		7		Large Power Tools		5


	Office
Office Chair		6		File Cabinet 2 Drawer		10
Computer		10		File Cabinet 3 Drawer		30
Copy Machine		20		File Cabinet 3 Drawer Wide		40
Computer Desk/Hutch		30		File Cabinet 4 Drawer		20
Secretary Desk		35		File Cabinet 4 Drawer Wide		60
Small Winthrop Desk		22		File Cabinet 5 Drawer		30
Fax /Printer/Scanner		3		Floor Lamp Pole		4
				Table Lamp		3


	0		0	TOTAL	0		0

BOXES	QTY	CU	CU TL
X-SMALL		1
SMALL		1.5
MEDIUM		3
LARGE		4.5
X-LARGE		6.5
WARDROBE BOXES		10
DISH PACKS		6
TOTAL	0		0


Inventory items not on list	QTY	C/F











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