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Date of Move:
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Type of Service:
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Destination:
From city-state:
To city-state:
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Approximate Weight: (if known)
Approximate number of rooms:
Type of Residence:
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House
Town House
Apartment
Condo
High Rise
What floor if your home is a condo or highrise?
Mode of transport:
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Stairs
Elevator
Ground level, no stairs or elevator
Any packing to be done?
Yes
No
Your Information:
Name:
E-Mail Address:
Phone:
Best time to call:
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Morning
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Address:
City, State & Zip:
Notes:
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