First and Last Name**
Home Phone
Cell Phone*
Email Address*
Current Address*
City and Province*
Move-out date*
New Address*
City and Province*
Move-in date*
LR - Bench, Deacon
LR - Bench, Piano
LR - Bookcase
LR - Bookshelves
LR - Wall Unit
LR - Chair, Arm
LR - Chair, Occasional
LR - Chair, Oversized
LR - Chair, Recliner
LR - Chair, Rocking
LR - Chair, Straight
LR - Chaise Lounge
LR - Curio Cabinet
LR - Fireplace Tools
LR - Footstool
LR - Futon
LR - Lamp, Floor/Pole
LR - Piano, Apartment
LR - Piano, Upright/Baby
LR - Piano, GR/Parlour
LR - Sofa, Loveseat
LR - Sofa, 3 Cushion
LR - Sofa, Hide-a-bed
LR - Stereo Comp
LR - Stereo, Mini
LR - Table, Coffee
LR - Table, End
LR - TV, Portable to 13in.
LR - TV, to 19in.
LR - TV, 32in. to 36in.
LR - TV, Big Screen to 50in.
LR - TV, Big Screen to 60in.
LR - TV Stand
LR - VCR/DVD
LR - Other Items Not Listed
DR - Dining Chair
DR - Buffet (Bottom)
DR - Hutch (Top)
DR - Server/Sideboard
DR - Table, Extension
DR - Table, Dining
DR - Tea Cart
DR - Tea Cart
DR - China Cabinet
DR - Breakfront
DR - Other Items Not Listed
Kit - Chair
Kit - High Chair
Kit - Microwave
Kit - Microwave Stand
Kit - Stool
Kit - Utility Cabinet
Kit - Breakfast Table
Kit - Table, Kitchen
Kit - Other Items Not Listed
App - Air Conditioner
App - Dehumidifier
App - Dishwasher
App - Dryer
App - Freezer, to 10 Cu-ft
App - Freezer, 11 to 15 Cu-ft
App - Freezer, 16 Cu-ft
App - Range
App - Refrigerator, to 6 Cu-ft
App - Refrigerator, 7 to 10 Cu-ft
App - Refrigerator, to 11 Cu-ft
App - Sewing Mach, Cabinet
App - Sewing Mach, Portable
App - Vacuum Cleaner
App - Washing Machine
App - Water Cooler
APP - Other Items Not Listed
Bed - Armoire
Bed - Bed, Single
Bed - Bed, Double
Bed - Bed, Bunk
Bed - Bed, King
Bed - Chest of Drawers, sm
Bed - Chest of Drawers, lg
Bed - Hope Chest
Bed - Dresser, Single
Bed - Dresser, Double
Bed - Dresser, Triple
Bed - Night Table
Bed - Vanity and Bench
Bed - Wardrobe, Large
Bed - Wardrobe, Small
Bed - Rug, Large
Bed - Rug, Medium
Bed - Rug, Large
Bed - Other Items Not Listed
Nur - Bassinet
Nur - Bed, Youth
Nur - Chair, Child
Nur - Crib
Nur - Play Pen
Nur - Change Table
Nur - Toy Box
Nur - Stroller
Nur - Carriage
Nur - Table
Nur - Childs Vehicle
Nur - Other Items Not Listed
Off - Chair, Office
Off - Computer System
Off - Credenza
Off - Desk, Student
Off - Desk, Office
Off - Desk, Modular
Off - Filing Cabinet, 2 Drawer
Off - Filing Cabinet, 4 Drawer
Off - Other Items Not Listed
Out - Garden Hose, Tools
Out - Ladder, Extension
Out - Ladder, Step
Out - Lawn Chair
Out - Lawn Chair, Stacking
Out - Lounge Chair
Out - Lawn Mower, Hand
Out - Lawn Mower, Power
Out - Slide
Out - Swings
Out - Picnic Table
Out - Rocker Swing
Out - Cement Ornaments
Out - BBQ
Out - Cement Pots
Out - Patio Tables
Out - Umbrella w/ Stand
Out - Wheelbarrow
Out - Sandbox
Out - Trash Can
Out - Other Items Not Listed
Misc - Bike, Child
Misc - Bike, Mountain
Misc - Bike, Exercise
Misc - Fan
Misc - Golf Bag w/ Clubs
Misc - Heater, Gas/Electric
Misc - Outboard Motor
Misc - Ping Pong table
Misc - Pool Table, Wood
Misc - Pool Table, Slate
Misc - Shelves, Metal
Misc - Snowblower
Misc - Tires
Misc - Tool Box
Misc - Tool Chest
Misc - Trunk
Misc - Universal Gym
Misc - Weights
Misc - Weight Bench
Misc - Work Bench
Misc - Other Items Not Listed
Cart - 2 Cu-ft Books
Cart - 2 Cu-ft
Cart - 4 Cu-ft
Cart - 5 Cu-ft
Cart - 6 Cu-ft
Cart - China Barrel
Cart - Crate
Cart - Totes
Cart - Mirror, small
Cart - Mirror, large
Cart - Wardrobe
Other Cartons or Special Notes
Any other information that you think Blakes Moving would need to know?
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