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Name

First

Last

Cell Phone Number

Please provide your Email Address

What type of moving service do you require?

Destination of your move?

Local Move

Move within your state

Move out of state

Pickup/Delivery from Home Depot/Lowes, Etc.

Move to or from a Storage Space

What is the size of your move?

Studio or 1 Bedroom Home/Apartment

2 or 3 Bedroom Home/Apartment

4 Bedroom or Larger Home

Office(s) or Office Building

Storage Space

Other (describe in comments section below)

Moving from Zip Code:

Moving to Zip Code:

Floors at current location?

Floors at destination?

Estimate how many boxes or cartons will need to be moved?

1-10 boxes/cartons

11-40 boxes/cartons

41 or more boxes/cartons

Please list your Desired Move Date(s) in order of preference?

Please list your heaviest item(s) and any special requirements or comments for this move

Please check all that apply below

I will wrap and secure any fragile items

I will identify any furniture that needs additional padding or special attention

I will disassemble all bedframes, furniture, and unplug all appliances

I might need additional boxes for wardrobe, dishes or other loose items

This is not the first time I have used a moving service

I understand that items transported in a truck can incur a few scratches, chips or slight damage even when padded or quilted

I would like to know more about the Full-Value Protection Plan

It's a local move, I realize the risk involved and I don't want to pay for extra protection