Name * First Name Last Name Phone * (###) ### #### Email * Date of Move * MM DD YYYY Type of Move (Apartment, House, Office, etc) * Current Address * If apartment, Which floor do you live on currently? * 1st 2nd 3rd 4th N/A Stairs or Elevators? * Stairs Elevator Bedrooms? * 0 1 2 3 4 5 6 Boxes? * 0-20 21-40 41-60 61-80 81-100 Item Checklist * New Address * If your new home will be a apartment, Which floor will you be moving to? * 1st 2nd 3rd 4th N/A Stairs or Elevators? * Stairs Elevators None Thank you!