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	Contact Information First Name: * Last Name: E-mail: * Telephone Number: Best time to contact you Morning Noon Evening Estimated Move Date: Moving From From Address: Apt/Rm/Ste: Elevator Yes No State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY zip * Apt. Size Studio 1 Bedroom 2 Bedroom 3 Bedroom House Moving To To Address: To Apt./Rm/Ste: To State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY To Zip: Items to move Living Room Bookcase Medium Ent. Center Large Ent. Center Lamps Pictures Stereo TV Cabinet Piano Chairs Tables Small Sofa/loveseat Large Sofa Rugs Dining Room Dining Table Straight Chair China Cabinet Curio Cabinet Rugs (Small Area) Hostess Trolley Server - Teacart Bedroom Single Bed Double Bed Queen Bed King Bed Bunk Bad Headboard Footboard Chest of Drawers Dresser Single Dresser Double Dresser Triple Dresser Night Table Dressing Table Misc: Bicycle Exercise equipment Desk, office Computers Filing cab. 2 door Filing cab. 4 door Fine Art Musical instruments Suitcase Trash can Kitchen Cabinet (Pantry) Dishwasher Ironing Board Microwave Oven 10cf or less Freezer 11-15cf Freezer 6cf or less Refrigerator 16cf or over 7-10cf Refrigerator 11cf or over Refrigerator Sewing Machine Microwave Cart Stool Stove Vacuum Cleaner Washing Machine Dryer Table Washer/Dryer Combo Straight Chair Porch & Outdoor: BBQ grill, small BBQ grill, large Lounge chairs Outdoor Table Dog House General Information Items of extraordinary value: Comments: