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    Customer Information
    Name*
    Home Phone*
    Current Address*
    Work Phone
    Current City*
    Cell Phone
    Current State*
    Fax Number
    Current ZIP*
    E-Mail*
    Current Chicagoland Neighborhood
     
     
    Current Suburban Neighborhood
     
     
    Approx. Move Date*
     
     
    New Address*
     
     
    New City*
     
     
    New State*
     
     
    New ZIP*
     
     
    New Chicagoland Neighborhood
     
     
    New Suburban Neighborhood
     
     
    Distance (in ft) from where the truck can park to your front door:
    Current Home/Apt
    New Home/Apt
    Number of flights of stairs to current front door (Over 8 steps):
    Current Home/Apt
    Elevator Available?
    Number of flights of stairs to new front door (Over 8 steps):
    New Home/Apt
    Elevator Available?
    How would you like to be contacted with your price?
    How did you hear about us?
    Special Notes:
    Living Rm
    Family Rm
    Qty
    Bedroom
    Den/Office
    Qty
    Kitchen
    Dinning Rm
    Qty
    Basement
    Attic/Misc.
    Qty
    Office / Shop
    Misc.
    Qty
    Bar - Portable
    Armoire
    Bakers Rack
    Air Conditioner
    Bar BQ / Grill
    Bench
    Bassinet
    Bench
    Baby Carriage
    Bike
    Bookcase
    Bed - Single
    Buffet
    Boxes - Large
    Garbage Can
    Chair, Arm
    Bed - Double
    Chair
    Boxes - Small
    Glider
    Chair, Overstuff
    Bed - Queen
    Chair, High
    Card Table
    Hose
    Chair, Recliner
    Bed - King
    China Cabinet
    Chair - Folding
    Hot Tub
    Chair, Rocker
    Bed - Bunk / Trundle
    Corner Cabinet
    Clothes Basket
    Ladder - Extension
    Clock, Grandfather
    Bed - Water, Assem
    Curio Cabinet
    Cooler
    Ladder - Step
    CD / Video Rack
    Bed - Water, Disass
    Dry Sink
    Cot
    Lawn Cart
    Desk, Small
    Bookcase
    Hutch
    Fan
    Lawn Chair
    Desk, Large
    Cedar Chest
    Ironing Board
    Foot Locker
    Lumber
    Electronics
    Chair, Childs
    Microwave
    Golf bag
    Metal Shelves
    Entertainment Center
    Changing Table
    Microwave Cart
    Gun Cabinet
    Motorcycle
    Fireplace Equipment
    Computer Pieces
    Serving Cart
    Gun Safe
    Mower - Push
    Foot Stool
    Copier
    Stool
    Metal Shelve
    Mower - Riding
    Hall Chest
    Credenza
    Table, Dining
    Pet Cage
    Outdoor Sculpture
    Lamp
    Crib
    Waste Basket
    Ping Pong Table
    Outdoor Tools
    Picture
    Desk - Large
    Water Cooler
    Pool Table
    Patio Chair
    Piano - Spinet
    Desk - Small
    Tea Cart
    Power Tool
    Patio Table
    Piano - Upright
    Dresser - Chest
     
     
    Sports Equipment
    Patio Umbrella
    Piano - Baby Grand
    Dresser - Double
    Appliances
    Storage Cabinet
    Picnic Bench
    Piano - Grand
    Dresser - Triple
    Clothes Dryer
    Suitcase
    Picnic Table
    Plant - Small
    Exercise Equipment
    Clothes Washer
    Table - Folding
    Planter
    Plant - Large
    File Cabinet - Large
    Dehumidifier
    Table - Utility
    Portable BB Hoop
    Rug - Small
    File Cabinet - Small
    Dishwasher
    Tackle Box
    Sled
    Rug - Large
    File Cabinet - Lat.
    Freezer
    Tool Chest
    Snow Blower
    Sofa - 2 Cusion
    Futon
    Humidifier
    Toy Chest
    Storage Cabinet
    Sofa - 3 Cusion
    Hamper
    Refrigerator - Dorm
    Toys - Large
    Swing Set
    Sofa - 4 Cusion
    Hanging Clothes 2'
    Refrigerator
    Trunk
    Tires
    Sofa - Hide-A-Bed
    Mirror
    Stove / Range
    Work Bench
    Tricycle
    Sofa - with Recliners
    Night Table
    Vacuum Cleaner
     
     
    Wheel Barrow
    Speakers
    Playpen
     
     
     
     
     
     
    Stereo Cabinet
    Sewing Machine
     
     
     
     
     
     
    Table - Coffee / End
    Treadmill
     
     
     
     
     
     
    Table - Drop / Occas
    Vanity
     
     
     
     
    Other
    TV - (19" or Less)
    Wardrobe Closet
     
     
     
     
    Other
    TV - (20" - 40")
    Work Table
     
     
     
     
    Other
    TV - (Over 40")
     
     
     
     
     
     
    Other
    TV / Snack Tray
     
     
     
     
     
     
    Other
    TV Stand
     
     
     
     
     
     
    Other