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Quote Request Form
Note: Hovering your cursor over items in Blue have more detailed explanations about that particular item.

Living Rm

Family Rm

Qty Bedroom

Office

Qty Kitchen

Dining Rm

Qty Basement

Attic

Qty Garage

Outside

Qty
Arm Chair Armoire Bakers Rack Bar-Portable Air Conditioner
Bookcase-Large Bassinet Bench Card Table Set BBQ/Grill
Bookcase-Small Bed-Single Buffet Clothes Dryer Bike
CD/Video Rack Bed-Double Chair Clothes Washer Garbage Can
Coffee/End Table Bed-Queen China Cabinet Cooler Glider
Electronics Bed-King Compactor Cot Hose
Enter. Center Bed-Bunk/Trundle Corner Cabinet Dehumidifier Ladder
Fire Place Equip Bed-Water,
Assembled
Curio Cabinet Fan Lawn Cart
Foot Stool Bed-Water,
Disassembled
Dishwasher Foot Locker Lawn Chair
Grandfather Clock Bookcase-Lg Hutch Freezer Lawn Mower
Hall Chest Bookcase-Sm Ironing Board Gun Cabinet Lumber
Lamp Cedar Chest Microwave Humidifier Metal Shelves
Piano-Baby Grand Changing Table Microwave Cart Metal Shelves Outdoor Sculpture
Piano-Spinet Clothes Tree Refrigerator Ping Pong Table Outdoor Tools
Piano-Upright Comp. Pieces Rug Pool Table Patio Chair
Picture Credenza Serving Cart Power Tools Patio Table
Plant-Lg Crib Stool Sports Equip Picnic Bench
Plant-Small Desk Chair Stove/Range Storage Cabinet Picnic Table
Recliner/Rocker Desk-Computer Table Suitcase Planter-Lg
Sofa-2 Cushion Desk-Lg Vacuum Cleaner Table-Folding Planter-Sm
Sofa-3 Cushion Desk-Sm Waste Basket Tool Chest Port. BB Hoop
Sofa-Hide-a-Bed Dresser/High Boy Water Cooler Toy Chest Riding Mower
Sofa w/ Recliner Exercise Equip     Toys-Lg Sand Box
Speakers File Cabinet-Lg     Work Bench  
Stereo Cabinet File Cabinet-Sm     Hoisting Service Snow Blower
TV 19" or less Futon         Storage Cabinet
TV 20"- 40" Hamper     Total Boxes-Small Swing Set
TV 40" Plus Hanging Clothes/2 ft     Total Boxes-Large Umbrella
TV Stand Mirror         Tires
TV Snack Trays Night Table

Use These Boxes For Any Unlisted Items

Wheel Barrow
Wall Unit Pieces Sewing Machine Other     
    Vanity Other     
    Wardrobe Other     
        Other     
        Other     
        Other     
Customer Information
Name Home Phone
Address  
Old Town  Old Zip  Work Phone
Old Home
E-Mail  
New Address Cell Phone
New Town  New Zip   
New Home
Move Date   Fax Number
 
Distance in feet from where the truck can park to your front door
Current Home/Apt  New Home/Apt 

Number of stairs to current front door

Current Home/Apt  Elevator Available?

Number of stairs to new front door

New Home/Apt  Elevator Available?

How would you like to be contacted with your price? 

Liability Coverage: 

Default
Option 1 (Valuation)
Option 2 (Additional Valuation)

Special Notes:

Please read the SUMMARY OF INFORMATION FOR SHIPPERS OF HOUSEHOLD GOODS before sending.
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