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Name of Contact

Location Type

Residential

Commercial

Date of Move

City to City # of miles

Phone Number

Cell Number

Company Name

City

State

Zip Code

Complex Name

Apt#

Gate Code

Building#

# of rooms

Square Footage

# of steps

Complex Name

Apt#

City

State

Zip Code

Gate Code

Building#

# of rooms

Square Footage

# of steps

# of bedrooms

Steps

Up

Down

King

Queen

Twin

Headboard

Poster

Motorized Bed

Crib (Please Disassemble)

Changing Table

Rocker

Bunkbed

Daybed

Waterbed

# of pieces

Night Stands

Marble

Dresser

Marble

Glass

Mirror

Chest

Armoir

TV

Plasma

Standing Mirror

Jewelry Stand

Chairs

Wardrobes ($6 ea/rental)

Table

Size

Glass

Leafs

Chairs

China Hutch

# of pieces

Rug

Buffet

Marble

Curio Cabinet

Artificial Tree

Couch

Leather

White Material

Sleeper

Leather

White Material

Recliner

Leather

White Material

White Material

Leather

Love Seat

Sectional

 of pieces

Leather

White Material

Oversized Chair

Leather

White Material

Ottamon

Leather

White Material

Coffee Table

Glass

Marble

Sofa Table

Glass

Marble

End Table

Glass

Marble

Entertainment Center

# of pieces

Stereo Stand

Speakers

TV

Big Screen

Plasma

Rug

Artificial Tree

Study Lamp

Table

Wood

Glass

Iron

Chairs #

Backers Rack

Freezer

Desk

# of Pieces

Return

Credenza

Hutch

File Cabinets

Bookcase

Conference Table

# of Chairs

Computer Stand

Copier

Printer

Computers

Boxes

Cubicles

Workbench

Length

Storage Cabinets

Supply Cabinets

Shelves

Metal

Plastic Tubs

Golf Clubs

Yard Ornaments

Lawn Equipment

Lawn Mower

Riding Lawn Mower

Bicycles

Other Lawn Equipment: (List out)

Patio Table

Glass Top

Chairs

Storage Cabinet

Chase Lounge

Glider

BBQ

Flower Pots

Swing Set

Dissemble

Assemble

Christmas Tree

Yard Ornaments

Plastic Tubs

Other (List Out)

Pool Table

Baby Grand

Upright Piano

Grandfather Clock

Treadmill, Exercise Equipment

Disassemble

Reassemble

Pictures

Decorative Mirrors

Steps

Small 1.5

Medium 6.1

Large 4.5

Extra Large 6.1

Dish Pac

Wardrobes