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Contact Information

Name:
E-Mail Address:
Home Phone:
Alt. Phone:
Referred By:

Moving From
Moving From:
Office/Apt. Floor:
Street Address:
City, State, Zip:
Elevator:

Moving To
Moving To:
Office/Apt. Floor:
Street Address:
City, State, Zip:
Elevator:
Preferred Date of Move:
Approx. Mileage:

Your Items

Please denote any items that will need special consideration, such as antiques, with an * next to the amount in the appropriate field.
A
adding machine:
air cond. 5-10 BTU's:
air cond. 10-15 BTU's:
air cond. 15 BTU's & over:
armoire:
B
baby, bassinette:
baby, carriage:
baby, changing table:
baby, chest:
baby, crib:
baby, desk:
baby, dresser:
bags:
bakers rack:
bar:
bar stools:
barbeque grill, charcoal:
barbeque grill, gas:
basket:
basket, wicker:
bed, bunk:
bed, canopy:
bed, day:
bed, double:
bed, frames:
bed, king:
bed, motorized:
bed, queen:
bed, rollaway:
bed, single:
bed, waterbed:
bed, youth:
bench, cedar:
bench, harvest:
bench, picnic:
bench, work:
bicycles:
bookcase, lg.:
bookcase, med.:
bookcase, sm.:
boxes, lg.:
boxes, med.:
boxes, sm.:
boxes, wardrobe:
buffet:
C
cabinet, china 1 pc.:
cabinet, china 2 pc.:
cabinet, corner:
cabinet, curio lg.:
cabinet, curio med.:
cabinet, curio sm.:
cabinet, filing 2 dr.:
cabinet, filing 4 dr.:
cabinet, filing 5 dr.:
cabinet, glass lg.:
cabinet, glass med.:
cabinet, glass sm.:
cabinet, kitchen lg.:
cabinet, kitchen med.:
cabinet, kitchen sm.:
cabinet, metal lg.:
cabinet, metal med.:
cabinet, metal sm.:
cabinet, utility lg.:
cabinet, utility sm.:
cabinet, wood lg.:
cabinet, wood med.:
cabinet, wood sm.:
cable box:
carpet cleaner:
cash register:
c.d. player:
chairs, aluminum:
chairs, arm:
chairs, beach:
chairs, childrens:
chairs, computer:
chairs, dinette:
chairs, dining:
chairs, folding:
chairs, iron:
chairs, kitchen:
chairs, lounge:
chairs, office:
chairs, ottoman:
chairs, overstuffed:
chairs, plastic:
chairs, rocking:
chairs, wheel:
chairs, wicker:
chairs, wingback:
chest, bedroom lg.:
chest, bedroom med.:
chest, bedroom sm.:
chest, cedar lg.:
chest, cedar sm.:
chest, hope:
chest, steamer lg.:
chest, steamer sm.:
chest, storage:
chest, tool lg.:
chest, tool med.:
chest, tool sm.:
chest, toy:
clock, grandfather:
clock, wall:
coffee maker:
computer:
copier:
cots:
credenza:
D
dehumidifier:
desk, childrens:
desk, computer wood:
desk, computer metal:
desk, corner:
desk, executive:
desk, roll top:
desk, secretary:
dishwasher:
dog house:
dresser, double:
dresser, double w/mirror:
dresser, double w/2 mirrors:
dresser, single:
dresser, single w/mirror:
dresser, single w/2 mirrors:
dresser, triple:
dresser, triple w/mirror:
dresser, triple w/2 mirrors:
dryer:
dvd player:
E
entertainment center, ex. lg.:
entertainment center, lg.:
entertainment center, med.:
entertainment center, sm.:
F
fans, box:
fans, ceiling:
fans, floor:
fireplace equipment:
foot locker:
footboard, double:
footboard, full:
footboard, king:
footboard, queen:
footboard, single:
foot stool:
freezer, 10 cu. ft. or less:
freezer, 11 to 15 cu. ft.:
freezer, 16 cu. ft. or over:
futon, metal lg.:
futon, metal med.:
futon, metal sm.:
futon, wood lg.:
futon, wood med.:
futon, wood sm.:
G
garden hose:
golf equipment:
gym or exercise equipment:
H
hall trees:
hamper:
hat rack:
headboard, double:
headboard, double w/ mirror:
headboard, full:
headboard, full w/ mirror:
headboard, king:
headboard, king w/ mirror:
headboard, queen:
headboard, queen w/ mirror:
headboard, single:
headboard, single w/ mirror:
heater, electric:
heater, gas:
heater, kerosene:
high chair:
hobby horse:
humidifier:
hutch, 1 pc.:
hutch, 2 pc.:
I
ironing boards:
L
ladder, step:
ladder, 6':
ladder, 8':
ladder, 12':
ladder, 18':
ladder, 24':
ladder, 36':
ladder, 48':
lamps, floor ceramic:
lamps, floor pole:
lamps, spider:
lamps, table ceramic:
lamps, table flourescent:
lamps, table glass:
lamps, table wood:
lawn equipment:
lawn mower, hand:
lawn mower, electric:
lawn mower, gas:
leaf blower, electric:
leaf blower, gas:
M
magazine rack:
microwave:
microwave stand:
milkcrates:
mirrors:
musical instruments:
O
outdoor childs gym:
outdoor childs slide:
outdoor dry racks:
outdoor swing set:
outdoor umbrella:
P
paint rack:
piano, baby grand:
piano, grand:
piano, spinet:
piano, upright:
pictures:
plastic totes:
playpen:
pool table:
pool table, slate:
R
rakes:
range, 20" wide:
range, 30" wide:
range, 35" wide:
range, double:
refrigerator, 5 cu. ft.:
refrigerator, 10 cu. ft.:
refrigerator, over 10 cu. ft.:
rowing machine:
rug, large:
rug, small:
S
safe:
sand box:
seed spreader:
server, lg.:
server, med.:
server, sm.:
sewing machine:
shelves:
sleds:
sofa, bed:
sofa, love seat:
sofa, love seat sleeper:
sofa, rattan:
sofa, reclining:
sofa, sectional:
sofa, three cushion:
sofa, wicker:
stair master:
statues:
stereo, component(s):
stereo, console:
stereo speakers:
suitcases:
T
table, card lg.:
table, card sm.:
table, childs:
table, coffee:
table, coffee w/ glass:
table, dinette:
table, dinette w/ glass:
table, dining:
table, dining w/ glass:
table, dropleaf:
table, end:
table, end w/ glass:
table, kitchen:
table, kitchen w/ glass:
table, night:
table, night w/ glass:
table, picnic:
table, ping pong:
table, utility:
tea cart:
telephone stand:
television, 17"-22":
television, 24"-27":
television, 30"-32":
television, over 32":
television, portable:
television stand:
tools, hand:
tools, power:
trashcans:
trash compactor:
treadmill:
tricycle:
trunk:
U
umbrella stand:
V
vacuum cleaners:
vcr:
W
wagon, childs:
washer/dryer combo:
washing machine:
weights (in lbs.):

Please type any items not listed above in the space provided:


We will respond to your submittal within 24 hours.

Dan Ewall
267-225-7052
dan@carefulmovingservices.com
www.carefulmovingservices.com