Full name:
 
Primary Phone number (ext):

Cell Phone:
 
Email Address:
 
Preferred method of contact: phone  e-mail
 
Best time to call:
 
Type of residence: Private house Apartment
 
Pickup Address:

House Number and Street: apt#

City:   State:

Floor (if applicable): Elevator: Yes No

Delivery Address:

House Number and Street: apt#

City:   State:
Floor (if applicable): Elevator: Yes No

Please type your furniture list:
 
Qty      Description