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Address: Address:

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State:

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Zip:

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Size of residence:
# of Bedrooms
# of Rooms
Flights of Stairs
Major Appliances

Size of residence:
# of Bedrooms
# of Rooms
Flights of Stairs

       

Will Temporary Storage be needed?

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Living Room Quantity
Arm Chair
Sofa
Love Seat
Rocking Chair
Lamp
Piano
Rugs
Stereo
Coffee Table
End Table
TV
Stand
Futon
E. Center
Ottoman
   
Office Quantity
Desk
File Cabinet
Picnic Table
Fan
Book Case
Grill
Suitcase
Work Bench
Computer
Exercise Equipment
Trunk
   
Boxes Quantity
Small
Medium
Large
Wardrobe
Picture
 
   
Dining Room Quantity
China Cabinet
Buffet
Chair
Table
Tea Cart
Hutch
   
Kitchen Quantity
Refrigerator
Freezer
Dryer
Washer
Table
Chairs
Cabinet
Vacuum
Microwave
A/C
   
Bedroom Quantity
Double Bed
Queen Bed
King Bed
Single Bed
Bureau
Chest
Dresser
Night Table
Armoire
Mirror
   
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