| First name: |
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| Last name: |
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| E-Mail Address: |
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| Day Phone: |
ext:
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| Evening Phone: |
ext:
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| Cell Phone: |
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| Best time to contact you: |
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| Estimated move date: |
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How did you find our web site? |
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| City : |
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| State: |
Zip Code:
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| Size of home: |
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| Elevator: |
Yes
No |
| If walk up, write # of Floors: |
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| City : |
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| State: |
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| Zip Code: |
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| Size of home: |
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| Elevator: |
Yes
No |
| If walk up, write # of Floors: |
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| No. of people living in the apartment: |
1
2
3
4
5 |
| Will you need: |
Packing
Unpacking
Storage |
| Will you need: |
Car Shipping
Make
Model
Year
Running? |
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Bookcase |
Sofa, loveseat |
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Cabinet |
Sofa, large |
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Chair, straight |
Stereo |
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Chair, arm |
Tables, coffee |
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Chair, rocker |
Tables, end |
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Chair, overstuffed |
TV, up to 30" |
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Entertainment center |
TV, larger than 30" |
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Entertainment center, large |
VCR |
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Lamps |
Piano
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Pictures |
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Rugs |
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Chest, cedar |
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Quantity |
Sizes |
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Buffet (base) |
Chair |
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Hutch (top) |
Server |
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Cabinet, corner |
Pictures |
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Rug (small) |
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Rug (large) |
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Dining table |
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Bed, single |
Dresser, single |
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Bed, double |
Dresser, double |
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Bed, queen |
Dresser, triple |
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Bed, king |
Night table |
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Bed, bunk (set 2) |
Pictures |
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Bookshelves (sectional) |
Lamps |
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Chair |
TV |
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Rug (small) |
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Rug (large) |
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Chest, armoire |
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Bed, youth |
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Chest, toy |
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Crib, baby |
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Table, child's |
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Aircond/window.sm |
Refrigerator (11 cu. ft. or over) |
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Aircond/window.lg |
Vacuum cleaner |
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Dishwasher |
Washing machine |
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Freezer 10 cf or or less |
Dryer |
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Freezer 10-15 |
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Freezer 16 or over |
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Refrigerator (6 cu. ft. or more) |
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Refrigerator (6 cu. ft. or less) |
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Refrigerator (7-10 cu. ft.) |
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| Appliance Service Required, such as disconnection or hook up |
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Chairs |
Serving cart |
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Breakfast table |
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Ironing board |
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Microwave oven |
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Desk, small |
Desk, office, large |
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Filling cabinet, 2 Drawers |
Filling cabinet, 4 Drawers |
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Filling cabinet, Letteral |
Computer |
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Fax |
Printer |
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Scanner |
Copier, stand alone |
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Copier, desk-top |
Credenza |
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Quantity |
Sizes |
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BBQ grill, small |
Chairs, metal |
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BBQ grill, large |
Table |
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Chairs, aluminum |
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Chairs, metal |
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Bicycle |
Wagon, child's |
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Desk, office |
Golf bag |
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Filing cab. 2 door |
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Filing cab. 4 door |
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Suitcase |
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Trash can |
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Book Box (Small) |
Linen Box (Medium) |
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China Box (Large) |
Wardrobe Box |
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Picture / Mirror Box |
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Comments:
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