Customer:

Contact Person:

Pickup Date:

Delivery Date:

Loading Address:

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Floor Level:

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Phone Number:

Extra Stop Address:

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1st Bedroom

2nd Bedroom

QTY

QTY

Bed

 King

Bed

 King

 Queen

 Queen

 Full

 Full

 Twin

 Twin

 Water Bed

 Water Bed

 Canopy

 Canopy

 Bunk Bed

 Trundle

 Daybed

Dresser

Dresser

Mirror

Mirror

Hutch

Hutch

Chest of Drawers

Chest of Drawers

Night Stand

Night Stand

Vanity

Vanity

Bench

Armoire

Cedar Chest

TV

Lingerie Chest

Other

Etagere

Jewelry Cabinet

Armoire

TV

Other

3rd Bedroom

4th Bedroom/Nursery

Bed

 King

Bed

 King

 Queen

 Queen

 Full

 Full

 Twin

 Twin

 Water Bed

 Water Bed

 Canopy

 Crib

 Bunk Bed

 Bunk Bed

 Trundle

 Trundle

 Daybed

 Daybed

Dresser

Dresser

Mirror

Mirror

Hutch

Hutch

Chest of Drawers

Chest of Drawers

Night Stand

Changing Table

Armoire

Night Stand

TV

Toy Box

Other

Rocker

Other

Kitchen/Dining Room

Appliances

Table

Refrigerator

Chairs

Washer

China Cabinet

Dryer

Buffet

Stove

Bakers Rack

Microwave

Butchers Block

Cart

Other

Other

Living Room

Den/Office

Desk

 Small

Couch

 Sofabed

 Secretary

 Sectional

 Computer

 Futon

 Executive

 RollTop

Love Seat

File Cabinet

Chair

Chair

Ottoman

Credenza

Rocker

Bookcase

Recliner

Coffee Table

Miscellaneous

Sofa Table

Boxes

End Table

Lawn Mower

TV

 Portable

Patio Furniture

 Console

Picnic Table

 Big Screen

Picture/Mirror

Entertainment Center/TV Stand

Area Rug

Stereo & Speakers

Lg. Plant

Floor Lamp

Sewing Machine

Curio Cabinet

Aquarium/Stand

Piano

 Spinet

Ex. Machine

 Upright

Bar/Stools

 Organ

Bike

 Grand

BBQ Grill

Grandfather Clock

Treadmill

Other

Tool Chest

Trunk

Draft Table

Safe

Approx. Weight of Safe

Other