Name*

Email*

Address*

Apartment #

Floor*

City*

State*

Zip Code*

Home Phone*

Work Phone

Cell Phone

Type of Dwelling

HOUSEAPARTMENTOFFICEOTHER

Name

Address*

Apartment #

Floor*

City*

State*

Zip Code*

Home Phone

If out of state or upstate please estimate mileage

Date of move

Please include an itemized inventory of each piece of furniture:
(example: 2 desks, 1 dining table, 4 beds, 2 couches, etc…)

Indicate each glass top, glass door, glass shelf, marble that is movable:
(example: 3 glass tops, 1 glass door, 2 glass shelves, 1 marble, etc...)

Indicate any disassembly and/or tight squeeze:

Number of rooms to be shipped:

Will packing be required?

YesNo

If no, how many boxes/totes will
be moved?

Will packing material be required?

YesNo

Additional Information: