Move Date: |
How did you hear about Great White Moving?
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Preferred method for us to contact you.
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First Name * |
Last Name |
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E-mail Address * |
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Home Phone |
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Work Phone |
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Fax: |
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Origination Address, City, State |
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Destination Address, City, State |
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Origination Zip Code |
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Destination Zip Code |
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| Living Room |
Office |
Sofa |
Office or Roll-Top Desk |
Loveseat |
Desk Extension |
Hide-a-Bed |
Desk Chair |
Chaise Lounger |
Credenza |
Futon |
Two Drawer Filing Cabinet |
Tv stand |
Four Drawer Filing Cabinet |
Organ |
Fire Proof Filing Cabinet |
Entertainment Center |
Conference Table |
Bookcases |
Drafting Table |
Recliners, Arm-Chairs, Rockers |
Copier |
Ottomans or Footstool |
Computer Desk |
Coffee or End-Table |
Hutch |
27" to 36" TV |
Computer Components (# of pcs) |
8" to 26" TV
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Treadmill/Elyptical |
Large screen TV |
Storage Cabinet |
Stereo Components, Speakers, VCRs |
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Lamps or Pictures |
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Piano (DOWNSTAIRS) |
Baby Grand Piano |
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| Bedroom |
MISCELLANEOUS |
Headboard or Footboard |
Bridge Bed / Wall unit (# pcs) |
King or Queen Size Bed* |
Boxes Less than 50 lbs. |
Full Size Bed |
Boxes More than 50 lbs. |
Twin Size Bed |
Glass Tops |
Bunk Bed |
Glass Shelves |
Water Bed |
Marble Tops |
Day Bed/Trundle Bed |
Area Rugs |
Dresser |
Large Plants |
Mirror (detached)* |
Small Plants |
Chest of Drawers |
Sewing Machines |
Armoire or Wardrobe (empty) |
Bar-B-Que or Bicycle |
Nightstand |
Patio Table |
Cedar Chest or Trunk |
Ironing Board or Vacuum |
Crib and/or Changing Table* |
Patio Chairs |
Linear Feet of Clothes (on rod) |
Lawn Mower |
Small Desk |
Metal Shelf |
Do you need us to dissassemble/reassemble beds or crib?
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Curio Cabinet |
Do you need us to remove mirror from dresser?
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Etagere' |
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Hall Tree |
| Dining Room |
KITCHEN |
Dining or Kitchen Table |
Stove or Oven |
Dining Chairs or Bar Stools |
Refridgerator or Freezer* |
China Cabinet (1 or 2 pieces) |
Washer or Dryer |
Buffet or Server |
Microwave |
Microwave Stand |
Do you need us to disassemble or hook-up appliances?
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Please mention anything not listed above: |
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Would you consider the majority of your furniture to be :
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Elevator at either location? |
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How many flights of stairs at "origin"? |
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How many flights of stairs at "destination"? |
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Walk in excess of 100' at either location? List each over 100' |
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"Sloped path" at either location? Please describe. |
Approximate number of miles from one point to next |
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