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Moving From:

*Name:
Address:
City, State, Zip:
Work Phone:
*Home Phone:
*E-Mail Address:
# of Flights of Stairs
Elevator Yes No 
Preferred Response:
How Did You Find Us?:
Approximate Moving Date:
Moving To:

Name:
Address:
City, State, Zip:
Work Phone:
Home Phone:
E-Mail Address:
# of Flights of Stairs
Elevator Yes No
Preferred Response:
How Did You Find Us?:
      *Required Fields
Item CF

Quantity

 Item CF

Quantity

 Item CF

Quantity
Bar, Portable 15 Fireplace Equipment 5 Sofa, 2 Cushions 35
Bench, Fireside or Piano 5 Foot Stool 2 Sofa, 3 Cushions 50
Bookcase 20 Lamp, Floor or Pole 3 Sofa, 4 Cushions 60
Bookshelves, sectional 5 Magazine Rack 2 Sofa, Sectional, per sect. 30
Chair, Arm 10 Music Cabinet 10 Stereo 20
Chair, Occasional 15 Piano, Baby Gr. or Upr. 70 Stud, Couch and Hideabed 50
Chair, Overstuffed 25 Piano, Parlor Grand 80 Tables, Dropl'f Occas. 12
Chair, Rocker 12 Piano, Spinet 60 Tables, Coffee, End or Nest 5
Chair, Straight 5 Radio, Table 2 Telephone Stand and Chair 5
Clock, Grandfather 20 Record Player Port. 2 Television Combination 25
Day Bed 30 Rugs, Large Roll or Pad 10 Television or Radio Console 15
Desk, Small or Winthrop 22 Rugs, Small Roll or Pad 3 Television Table Model 10
Desk, Secretary 35
Dining Room
Item CF

Quantity

 Item CF

Quantity

 Item CF

Quantity
Bench, Harvest 10 Chair, Dining 5 Tea Cart 10
Buffet 30 Server 15 Rugs, Large Roll or Pad 10
Cabinet, Corner 20 Table Dining 30 Rugs, Small Roll or Pad 3
Cabinet, China 25
Bedroom
Item CF

Quantity

 Item CF

Quantity

 Item CF

Quantity
Bed, Incl. Spring and Mattr. Please select below Bureau, Dresser, Chest of Drawers 25 Dresser, Double (Mr.  & Mrs.) 50
Bed, Double 60 Cedar Chest 15 Night Table 5
Bed, King Size 70 Chair, Boudoir 10 Rugs, Large Roll or Pad 10
Bed, Single or Hollywood 40 Chair, Straight or Rocker 5 Rugs, Small Roll or Pad 3
Bed, Rollaway 20 Chaise Lounge 25 Vanity Dresser 20
Bed, Bunk (set of 2) 70 Desk, Small or Winthrop 22 Wardrobe, Small 20
Bookshelves 5 Dresser of Vanity Bench 3 Wardrobe, Large 40
Nursery
Item CF

Quantity

 Item CF

Quantity

 Item CF

Quantity
Bassinette 5 Chest 12 Pen, Play 10
Bed, Youth 30 Chest, Toy 5 Rugs, Large Roll or Pad 10
Chair, Childs 3 Crib, Baby 10 Rugs, Small Roll or Pad 3
Chair, High 5 Table, Child

5
Kitchen
Item CF

Quantity

 Item CF

Quantity

 Item CF

Quantity
Breakfast, Suite Chairs 5 Kitchen Cabinet 30 Table 5
Breakfast Table 10 Roaster 5 Utility Cabinet 10
Chair, High 5 Serving cart 15 Vegetable Bin 3
Ironing Board 2 Stool 3
Appliances
Item CF

Quantity

 Item CF

Quantity

 Item CF

Quantity
Air Conditioner 30 Ironer or Mangle 12
Dehumidifier 10 Range, Electric or Gas 30
Dishwasher 20 Refrigerator, 

Please select below
Dryer, Electric or Gas 25 6 Cubic Feet or less 30
Freezer, Cu. Capacity  Please select below 7 to 10 Cubic Feet 45
10 Cubic Feet or less 30 11 Cubic Feet or More 60
11 to 15 Cubic Feet 45 Vacuum Cleaner 5
16 Cubic Feet and Up 60 Washing Machine 25
Porch, Outdoor Furniture and Equipment
Item CF

Quantity

 Item CF

Quantity

 Item CF

Quantity
Barbecue or Port. Grill 10 Lawn Mower, Power 15 Rocker, Swing 15
Bath, Bird 5 Lawn Mower, Riding 35 Roller, Lawn 15
Chairs, Lawn 5 Leaf Sweeper 5 Rug, Large 7
Chairs, Porch 10 Outdoor Childs Slide 10 Rug, Small 3
Clothes, Line 5 Outdoor Childs Gym 20 Sand Box 10
Clothes, Dryer Rack 5 Outdoor Drying Racks 5 Settee 20
Garden Hose and Tools 10 Outdoor Swings 30 Spreader 1
Glider or Settee 20 Picnic Table 20 Table 10
Ladder, Extension 10 Picnic Bench 5 Umbrella 5
Lawn Mower, Hand 5 Porch Chair 10 Wheel Barrow 8
Miscellaneous
Item CF

Quantity

 Item CF

Quantity

 Item CF

Quantity
Ash or Trash Can 7 Fan 5 Sewing Machine 10
Basket (Clothes) 5 Fernery or Plant Stands 10 Sled 2
Bicycle 10 Foot Lockers 5 Step Ladder 5
Bird Cage and Stand 5 Garbage Cans 7 Suitcase 5
Card Table 1 Golf Bag 2 Table, Utility 5
Cabinet, Filing 20 Heater, Gas or Electric 5 Tackle Box 1
Carriage, Baby 20 Incinerator 10 Tool Chest 10
Chairs, Folding 1 Metal Shelves 5 Tricycle 5
Clothes, Hamper 5 Ping Pong Table 20 Wagon, Child's 5
Cot, Folding 10 Pool Table 40 Waste Paper Basket 2
Desk, Office 30 Power Tools 20 Work Bench 20
Boxes
Small   Large   Picture  
Medium   Wardrobe  
Comments