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Name (First & Last): * 
Home Ph*
Day Ph. 
Work Ph
Email:  
Approximate Moving Date: * 
Zip Code - Moving from * 
Flights of stairs? * 
Zip Code- Moving to: *
Flights of stairs? *
Zip Code for extra stop, if any: 
Flights of stairs?
Do you require packing services?  
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Living Room

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Sofa

Loveseat

Hide-a-bed or
Reclining Sofa

Sofa Pit Group
(No. of pieces)

Arm Chair

Recliner

Rocker

Ottoman

Coffee Table

End Table

Sofa Table

Futon

Etagers

Entertainment
Center

Wall Unit Pieces

Bigscreen TV

TV, Console

TV, Portable

TV Stand

Stereo Pieces

Stereo, Portable

Speakers

    Stereo Cabinet

Other(specify)

Other(specify)

     Other(specify)

 
Dining Room

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   Dining Table

        Dining Chairs

        Bar Stools

China Cabinet

Curio Cabinet

Buffet

Side Board

Cart

Other(specify)

Other(specify)

Other(specify)

Other(specify)

Kitchen

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Microwave

  Microwave Stand

       Refrigerator

Freezer

Washer

Dryer

  Baker's Rack

Other(specify)

Other(specify)

Bedrooms

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King Size Bed

    Queen Size Bed

Full Size Bed

Twin Size Bed

Headboard/
Footboard

Bridge Bed

Water Bed

Bunk Bed

Day Bed

Baby Crib

Dresser

Chest of Drawers

Vanity

Night Stand or
Lamp Table

Mirrors

Clothes,
(per Foot)

Trunk

Cedar Chest

Footlocker

Armoire

Other(specify)

Other(specify)

Other(specify)

Other(specify)

Office

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   Bookcase

    Desk, Secretary
or Writing

       Desk, Office
or Roll Top

Hutch

Credenza

File Cabinet,
Large

  File Cabinet,
Small

Table or
Folding Table

Chair, Small

Computer
Pieces

Stand

Other(specify)

Other(specify)

Other(specify)

Other(specify)

Boxes and Misc. Items

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Boxes Sealed
(one-man)

Boxes Sealed
(two-man)

Glass Top

Mirrors

Picture, Large

Picture, Small

VCR

Chair, Small

Fans

Lamps

Vacuum Cleaner

Ironing Board

Piano, upright

Bench

Grandfather
Clock

Plants

Sewing Mach

Aquarium

Stand

Suit Cases

Bike/Ex. Bike

Exercise Mach

Treadmill

Weight Bench

Weights
(pounds)

Patio Table

Patio Chairs

BBQ Grill,
(large)

BBQ Grill.
(small)

Lawn Mower

Other(specify)

Other(specify)

Other(specify)
Please list mirrors, glasstops,
and marble tops item:
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