Shipper Form

Moving Household Goods

Your first name:	Last name:
Your email:	Your fax number:
Your phone#:	Other phone#:

origin
Address:
City:		To help find this city, please enter the nearest large city:
State:
Country:
Zipcode:

destination
Address:
City:		To help find this city, please enter the nearest large city:
State:
Country:
Zipcode:

When do you plan on Moving?

Some things to consider before filling out the rest

Bedroom Items:


King Bed:	Queen Bed:	Bunk Bed:	Double Bed:
Single Bed:	Roll-Away:	Bookcase Section:	Cedar Chest:
Bedroom Chair:	Bench:	Chest 3 Drawer:	Chest 4 Drawer:
Bedroom Desk:	Dresser Chest:	Double Dresser:	Night Table:
Small TV:	Medium TV:	Vanity:

Nursery Items:


Nursery Bed:	Chair:	Nursery Chest:	Toy Chest:
Crib:	Playpen:	Changing Table:	Portable TV:

Kitchen:


Bar Stool:	Kitchen Chair:	Ironing Board:	Kitchen Cabinet:
Microwave Cart:	Small Kitchen Table:	Large Kitchen Table:

Dining Room Items:


Bench:	Buffet:	Small Cabinet Section:	Medium Cabinet Section:
Large Cabinet Section:	Dining Room Chair:	Side Table:	Dining Room Table:

Family Room, Living Room, Office:


Bench:	Book Case:	Book Case Section:	Straight Chair:
Arm Chair:	Rocking Chair:	Occasional Rocker:	OverStuffed Chair:
Desk:	Secretary Desk:	Fireplace Set:	Floor Lamp:
Small organ:	Large organ:	Piano - Spinet:	Baby Up Piano:
Grand Piano:	2-Cushion Sofa:	3-Cushion Sofa:	4-Cushion Sofa:
Hide-a-Bed:	Speaker:	Stereo Cabinet:	Small Table:
Large Table:	Medium TV:	HI-FI:	Large Screen TV:
Portable TV:	Computer:	Computer Monitor:	Computer Printer: