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Customer Information
Name*
Home Phone*
Current Address*
Work Phone
Current City*
Cell Phone
Current State*
---
IL
Fax Number
Current ZIP*
E-Mail*
Current Chicagoland Neighborhood
---
Rogers Park
West Ridge
Uptown
Lincoln Square
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
O’Hare
Edgewater
North Center
Lakeview
Lincoln Park
Avondale
Logan Square
Portage Park
Irving Park
Dunning
Belmont Cragin
Hermosa
Near North Side
Loop
Near South Side
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
Washington Park
Hyde Park
Woodlawn
South Shore
Bridgeport
Greater Grand Crossing
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
Current Suburban Neighborhood
. Addison
. Algonquin
. Alsip
. Antioch
. Arlington Heights
· Aurora
· Bannockburn
· Barrington
· Bartlett
· Batavia
· Bedford Park
· Bensenville
· Berwyn
· Bloomingdale
· Blue Island
· Bolingbrook
· Bourbonnais
· Bradley
· Bridgeview
· Broadview
· Brookfield
· Buffalo Grove
· Burbank
· Burr Ridge
· Calumet Park
· Carol Stream
· Carpentersville
· Cary
· Cedar Lake
· Channahon
· Chicago
· Chicago Heights
· Chicago Ridge
· Cicero
· Country Club Hills
· Countryside
· Crest Hill
· Crestwood
· Crystal Lake
· Darien
· Deer Park
· Deerfield
· Des Plaines
· Dolton
· Downers Grove
· Dundee
· East Chicago
· Elgin
· Elk Grove Village
· Elmhurst
· Elmwood Park
· Evanston
· Evergreen Park
· Forest Park
· Fort Sheridan
· Fox Lake
· Frankfort
· Franklin Park
· Gary
· Geneva
· Glen Ellyn
· Glencoe
· Glendale Heights
· Glenview
· Grayslake
· Great Lakes
· Gurnee
· Hammond
· Hanover Park
· Harvey
· Harwood Heights
· Hazel Crest
· Hickory Hills
· Highland
· Highland Park
· Highwood
· Hillside
· Hinsdale
· Hobart
· Hoffman Estates
· Homer Glen
· Homewood
· Hoopeston
· Huntley
· Island Lake
· Itasca
· Joliet
· Kankakee
· La Grange
· La Grange Highlands
· La Grange Park
· Lake Bluff
· Lake Forest
· Lake Station
· Lake Villa
· Lake Zurich
· Lake in the Hills
· Lansing
· Lemont
· Libertyville
· Lincolnshire
· Lincolnwood
· Lindenhurst
· Lisle
· Lockport
· Logan Square
· Lombard
· Lyons
· Markham
· Matteson
· McCook
· McHenry
· Melrose Park
· Merrillville
· Metteson
· Midlothian
· Mokena
· Monee
· Montgomery
· Morris
· Morton Grove
· Mount Prospect
· Mundelein
· Naperville
· New Lenox
· Niles
· Norridge
· North Aurora
· North Chicago
· North Riverside
· Northbrook
· Northfield
· Northlake
· Oak Brook
· Oak Forest
· Oak Lawn
· Oak Park
· Oakbrook Terrace
· Orland Park
· Oswego
· Palatine
· Palos Heights
· Palos Hills
· Palos Park
· Park Forest
· Park Ridge
· Pilsen
· Plainfield
· Prospect Heights
· Ringwood
· River Forest
· River Grove
· Riverdale
· Riverside
· Riverwoods
· Rolling Meadows
· Romeoville
· Roselle
· Rosemont
· Round Lake
· Round Lake Beach
· Schaumburg
· Schererville
· Schiller Park
· Skokie
· South Barrington
· South Elgin
· South Holland
· South Hollnd
· Spring Grove
· St. Charles
· St. John
· Steger
· Streamwood
· Sugar Grove
· Summit Argo
· Third Lake
· Tinley Park
· Vernon Hills
· Villa Park
· Warrenville
· Wauconda
· Waukegan
· West Chicago
· West Dundee
· Westchester
· Western Springs
· Westmont
· Wheaton
· Wheeling
· Willow Springs
· Willowbrook
· Wilmette
· Wilmington
· Winfield
· Winnetka
· Wonder Lake
· Wood Dale
· Woodridge
· Woodstock
· Worth
· Yorkville
· Zion
Approx. Move Date*
New Address*
New City*
New State*
---
IL
New ZIP*
New Chicagoland Neighborhood
---
Rogers Park
West Ridge
Uptown
Lincoln Square
Edison Park
Norwood Park
Jefferson Park
Forest Glen
North Park
Albany Park
O’Hare
Edgewater
North Center
Lakeview
Lincoln Park
Avondale
Logan Square
Portage Park
Irving Park
Dunning
Belmont Cragin
Hermosa
Near North Side
Loop
Near South Side
Humboldt Park
West Town
Austin
West Garfield Park
East Garfield Park
Near West Side
North Lawndale
South Lawndale
Lower West Side
Garfield Ridge
Archer Heights
Brighton Park
McKinley Park
New City
West Elsdon
Gage Park
Clearing
West Lawn
Chicago Lawn
West Englewood
Englewood
Armour Square
Douglas
Oakland
Fuller Park
Grand Boulevard
Kenwood
Washington Park
Hyde Park
Woodlawn
South Shore
Bridgeport
Greater Grand Crossing
Ashburn
Auburn Gresham
Beverly
Washington Heights
Mount Greenwood
Morgan Park
Chatham
Avalon Park
South Chicago
Burnside
Calumet Heights
Roseland
Pullman
South Deering
East Side
West Pullman
Riverdale
Hegewisch
New Suburban Neighborhood
. Addison
. Algonquin
. Alsip
. Antioch
. Arlington Heights
· Aurora
· Bannockburn
· Barrington
· Bartlett
· Batavia
· Bedford Park
· Bensenville
· Berwyn
· Bloomingdale
· Blue Island
· Bolingbrook
· Bourbonnais
· Bradley
· Bridgeview
· Broadview
· Brookfield
· Buffalo Grove
· Burbank
· Burr Ridge
· Calumet Park
· Carol Stream
· Carpentersville
· Cary
· Cedar Lake
· Channahon
· Chicago
· Chicago Heights
· Chicago Ridge
· Cicero
· Country Club Hills
· Countryside
· Crest Hill
· Crestwood
· Crystal Lake
· Darien
· Deer Park
· Deerfield
· Des Plaines
· Dolton
· Downers Grove
· Dundee
· East Chicago
· Elgin
· Elk Grove Village
· Elmhurst
· Elmwood Park
· Evanston
· Evergreen Park
· Forest Park
· Fort Sheridan
· Fox Lake
· Frankfort
· Franklin Park
· Gary
· Geneva
· Glen Ellyn
· Glencoe
· Glendale Heights
· Glenview
· Grayslake
· Great Lakes
· Gurnee
· Hammond
· Hanover Park
· Harvey
· Harwood Heights
· Hazel Crest
· Hickory Hills
· Highland
· Highland Park
· Highwood
· Hillside
· Hinsdale
· Hobart
· Hoffman Estates
· Homer Glen
· Homewood
· Hoopeston
· Huntley
· Island Lake
· Itasca
· Joliet
· Kankakee
· La Grange
· La Grange Highlands
· La Grange Park
· Lake Bluff
· Lake Forest
· Lake Station
· Lake Villa
· Lake Zurich
· Lake in the Hills
· Lansing
· Lemont
· Libertyville
· Lincolnshire
· Lincolnwood
· Lindenhurst
· Lisle
· Lockport
· Logan Square
· Lombard
· Lyons
· Markham
· Matteson
· McCook
· McHenry
· Melrose Park
· Merrillville
· Metteson
· Midlothian
· Mokena
· Monee
· Montgomery
· Morris
· Morton Grove
· Mount Prospect
· Mundelein
· Naperville
· New Lenox
· Niles
· Norridge
· North Aurora
· North Chicago
· North Riverside
· Northbrook
· Northfield
· Northlake
· Oak Brook
· Oak Forest
· Oak Lawn
· Oak Park
· Oakbrook Terrace
· Orland Park
· Oswego
· Palatine
· Palos Heights
· Palos Hills
· Palos Park
· Park Forest
· Park Ridge
· Pilsen
· Plainfield
· Prospect Heights
· Ringwood
· River Forest
· River Grove
· Riverdale
· Riverside
· Riverwoods
· Rolling Meadows
· Romeoville
· Roselle
· Rosemont
· Round Lake
· Round Lake Beach
· Schaumburg
· Schererville
· Schiller Park
· Skokie
· South Barrington
· South Elgin
· South Holland
· South Hollnd
· Spring Grove
· St. Charles
· St. John
· Steger
· Streamwood
· Sugar Grove
· Summit Argo
· Third Lake
· Tinley Park
· Vernon Hills
· Villa Park
· Warrenville
· Wauconda
· Waukegan
· West Chicago
· West Dundee
· Westchester
· Western Springs
· Westmont
· Wheaton
· Wheeling
· Willow Springs
· Willowbrook
· Wilmette
· Wilmington
· Winfield
· Winnetka
· Wonder Lake
· Wood Dale
· Woodridge
· Woodstock
· Worth
· Yorkville
· Zion
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?
OFF
ON
Number of flights of stairs to new front door (Over 8 steps):
New Home/Apt
Elevator Available?
OFF
ON
How would you like to be contacted with your price?
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Home Phone
Email
Cell Phone
Work Phone
Fax Machine
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