1. Where are you moving from?
	Address:
	City:
	State:
	Zip Code:
	Do You Require A Moving Permit?	Yes No Not Sure
	Are you moving from a:	House? Apt? Condo? Other?
	What floor(s) is your current dwelling on?
	Is there an elevator?	Yes No
	Please enter a few details about your current and future homes to help us get a more accurate estimate (optional). Enter Details Here
2. Where are you moving to?
	Address:
	City:
	State:
	Zip Code:
	Do You Require A Moving Permit?	Yes No Not Sure
	Are you moving to a:	House? Apt? Condo? Other?
	What floor(s) is your current dwelling on?
	Is there an elevator?	Yes No
	Please enter a few details about your current and future homes to help us get a more accurate estimate (optional). Enter Details Here
3. Desired Moving Date:
	Load Date:	AM PM Either
	Deliver Date:	AM PM Either
4. General Moving Information (Moving From)
	Are there stairs in front of the house?	Yes No
	Est. distance from front door to truck parking space:	feet
	Number of adults:	Number of children:
5. General Moving Information (Moving To)
	Are there stairs in front of the house?	Yes No
	Est. distance from front door to truck parking space:	feet
6. Room Information
	(enter appropriate number of rooms)
	Living Room(s)	Exercise/Playroom(s)
	Dining Room(s)	Garage
	Kitchen(s)	Basement
	Bed Room(s)	Storage Unit
	Den/Office(s)	Attic
7. Item Information
	Are any goods antiques or of high-value?	Yes No
	Will you need packing?	Yes No
	If you require partial packing, please check the types of goods:
	Artwork	Fragiles
	Kitchen	Dining Room
	Will you need storage?	Yes No Maybe
8. Specialty/Oversize X Items
	Please check any of the following items to be moved:
	Fridge	Freezer
	Washer/Dryer	Big Screen TV
	Grandfather Clock	Piano
	Pool Table (wood)	Pool Table (slate)
9. Bedroom Items
	King-Size Bed	Queen-Size Bed
	Double Bed	Single Bed
	Bunk Bed	Crib/Water Bed
	Dresser	Armoire
	Wardrobe	Night Table
	Large Bookcase	Small Bookcase
	Television	VCR/Component
	TV Stand	Lamp
	Hope Chest	Clothes Hamper
	Large Carton	Medium Carton
	Small Carton	Wardrobe Carton
10. Living Room Items
	Sofa	Love Seat
	Oversize Chair	Rocking Chair
	End Table	Drop/Occ. Table
	Coffee Table	Curio Cabinet
	Large Bookcase	Small Bookcase
	Television	VCR/Component
	TV Stand	Floor Lamp
	Armoire	Stereo Cabinet
	Computer Desk	Secretary Desk
	Computer	Ent. Center
	Large Carton	Medium Carton
	Small Carton	Wall Picture
11. Kitchen/Dining Room Items
	Dining Room Table	Kitchen Table
	Drop/Occ. Table	Microwave
	Hutch (base)	Hutch (top)
	Corner Cabinet	Baker's Rack
	Chair	Server
	Television	VCR/Component
	Large Carton	Medium Carton
	Small Carton	Wall Picture
12. Den/Office Items
	Sofa	Love Seat
	Futon	Chair
	Large Bookcase	Small Bookcase
	End Table	Coffee Table
	Filing Cabinet (2dr)	Filing Cabinet (4dr)
	Computer Desk	Large Desk
	Desk Chair	Computer
	Television	TV Stand
	Entertainment Center	Lamp
	Large Carton	Medium Carton
	Small Carton	Wall Picture
13. Exercise/Playroom Items
	Barbells (20 lbs)	Weight Bench
	Stair Climber	Treadmill
	Total Fitness	Stationary Bike
	Toy Chest	Play Structure
	Child's Table	Futon
	Television	VCR/Component
	TV Stand	Chair
	Large Bookcase	Small Bookcase
	Large Carton	Medium Carton
	Small Carton	Wall Picture
14. Garage/Outdoor Items
	Lawn Mower	Tractor Mower
	Lawn Edger	Lawn Spreader
	Power Tools (sm)	Power Tools (lg)
	Toolchest (sm)	Toolchest (lg)
	Yard Tools	Trash can
	Work Bench	Storage Cabinet
	Wheel Barrow	Garden Hose
	Ladder (6')	Ladder (8')
	Ladder (ext.)	Tire
	Metal Shelves	Freezer
	Wagon	Air Conditioner
	Outdoor Table	Outdoor Chair
	BBQ Grill	Bicycle
	Baby Carriage	Play Structure
	Sand Box	Swing Set
	Golf Bag	Large Carton
	Medium Carton	Small Carton
15. Contact Information
	Name*
	Phone Number *
	Email*
	* required for estimate If you don't fill out this section we are not going to be able to contact you !
Please be informed that the information you have provided on this form will not be disclosed to any other personnel or third party other than TLC Moving personnel.