Part I:
ORIGINAL INFORMATION:

(Fields marked with a *  are required)
 . 
*Last Name: 

*First Name: 

*  Address (line1): 

  Address(line2): 

*City/Town: 

*Province/State: 

  Country: 

  Postal/Zip Code: 

* Phone Number(1): 

  Phone Number(2): 

  Fax Number: 

* Area Code: 

  * E-Mail Address: 

  Approximate Move Date:  * 
 (DD)     (MM)      (YY)

NEW LOCATION:
 
 
   Address(line1): 

  Address (line2): 

* City/Town: 

* Province/State: 

   Country: 

   Postal/Zip Code: 
Phone Number (1):
Phone Number 2:
Fax Number:
Area Code: 

 
 
          
 
                
                  


                    

                    Part II:

                    LIVING ROOM:

                  
 
 
Bookshelves: 

Chairs, Arm: 

Chairs, Rocker (wood): 

Chairs, Overstuffed: 

Chairs, Straight: 

Desks, Small: 

Fireplace Equipment: 

Floor Lamps: 

Foot Stools-Ottomans: 

Grandfather Clocks: 

Grandmother Clocks: 

Hall Tree Racks: 

Hide-a-beds: 

Magazine Racks: 

Organs: 

Piano Apts.(incls bench): 

Pianos, Baby Grand Upright (incls bench): 

Radio Cassette Recorders: 

Rugs - Pads, Large: 

Rugs - Pads, Small: 

Sofa, Loveseat: 

Sofa, Loveseat (three-cushion): 

Speakers: 

Stereo Cabinets: 

Stereo Components: 

Tables, Coffee-End-Nest: 

Television, Consoles: 

Television, Table-Tops - Stands:  

VCRs  :

Wall Units: 



			 



DINING  ROOM:

		 
 
		 

Breakfronts (one piece):  

Buffets (bottom): 

Chairs: 

Corner Cabinets: 

Hutch (top) :

Rugs - Pads, Large: 

Rugs - Pads, Small: 

Servers/Tea Carts: 

Tables, Dinette: 

Tables, Extension: 


  

 
 
  Part IV:

			  

  APPLIANCES:

 
 
  

  
Air Conditioners: 

Dehumidifiers: 

Dishwashers: 

Dryers: 

Floor Polishers: 

Freezers (cu.cap.)ten or less: 

Freezers (cu.cap.)eleven - fifteen: 

Freezers (cu.cap.)sixteen and over: 

Humidifiers: 

Microwave Ovens: 

Ranges: 

Refrigerators (cu.cap.)six or less: 

Refrigerators (cu.cap.)seven - ten: 

Refrigerators (cu.cap.)eleven and over: 

Sewing Machine, Cabinets: 

Sewing Machines, Portable: 

Trash Compactors: 

Vacuum Cleaners: 

Washers: 


 

				 
PORCH, OUTDOOR 
 
				FURNITURE 

				 & EQUIPMENT:

                  
 
				 

Barbeques, Charcoal: 

Barbeques, Gas: 

Chaise Lounge: 

Garden Hoses: 

Ladders, Extension: 

Ladders, Step: 

Lawn Chairs: 

Lawn Tables: 

Lawn Umbrellas: 

Mowers, Electric: 

Mowers, Gas: 

Mowers, Riding (1-7 hp): 

Outboard Motors: 

Outdoor Swings: 

Picnic Tables: 

Snow Blowers: 

Tools, Garden (per 6): 

Wading Pools, Child's: 

Wheelbarrows: 


     

   
 
 

   
		 



			 Part III:

			 BEDROOM:

			 
 
			 

Beds, Single: 

Beds, Double: 

Beds, King-Queen-Water: 

Beds, Bunk (set of two): 

Cedar Chests: 

Chairs: 

Desks, Small: 

Dressers, Single: 

Dresssers, Double: 

Dressers, Triple: 

Rugs - Pads, Large: 

Rugs - Pads, Small: 

Televisions Table-Tops & Stands: 

Vanities (incls.bench): 

Wardrobes, Wood: 



   

    
NURSERY:

                  
 
                    

Bathinettes: 

Chairs: 

Chests, Drawer: 

Chests, Toy: 

Cribs: 

Night Tables: 

Playpens: 

Rugs - Pads, Large: 

Rugs - Pads, Small: 



      

          
KITCHEN:

                  
 
                    

Buffets: 

Chairs, Straight: 

Chairs, High: 

Ironing Boards: 

Stools: 

Tables, four feet or less: 	

Tables, five - six feet: 

Televisions, Portable: 


 


Part V:


MISCELLANEOUS:

 
 


Ash/Trash Cans: 

Bicycles: 

Cabinets, Filing (two dr): 

Cabinets, Filing (four dr): 

Carriages, Baby: 

Clothes Hampers: 

Computers & Printers:  

Desks, Office: 	

Exercise Bikes: 

Fans: 

Folding Chairs/Tables: 

Golf Bags, Skis, Sleds: 

Gun Cabinets: 

Heaters, Gas/Elec.: 

Ping Pong Tables: 

Plant Stands: 

Pool Tables four by eight feet: 

Pool Tables, Slate: 

Power Saws, Floor Model: 

Rowing Machines: 

Shelves, Metal: 

Strollers: 

Suitcases: 

Tires: 

Tires, Mounted: 

Tool Chests, Small: 

Tool Chests, Large: 

Trunks, Steamer: 

Typewriters: 

Vehicles, Childs: 

Work Benches: 


  
CONTAINERS/CARTONS:

                    If you wish to have us pack the cartons, 

                    check the checkbox next to the item.

                  
 

Cartons (two cu.ft): 

Cartons (four cu.ft): 

Cartons (five cu.ft): 

Cartons (six cu.ft): 

Cartons (Books): 

China Barrels: 

Gun Cartons: 

Cartons, Mirror, Small: 

Cartons, Mirror, Large: 

Wardrobes: 

Miscellaneous Cartons: 



                  

                  
 
                

              

              
 
                Part 
                  VI:

                  OTHER POSSESSIONS:		
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