CONTACT INFORMATION
First Name Last Name
Street Address Apt/Unit#
City State Zip
Day Phone Eve Phone Fax
E-mail

*How did you hear about Hartman Relocation?  

If referred, who referred you?   

*This field mandatory.

GENERAL INFORMATION
How do you prefer to be contacted?
What city/town are you moving from?
What state/country are you moving from?
What city/town are you moving to?
What state/country are you moving to?
What date are you looking to move?

Old Residence
How many flights of stairs from ground floor to your current residence?
What type of stairs?
If there is an elevator, how long is the walk from your apt. to the elevator? feet
From the elevator to the door at the lobby? feet
From the building to the truck? feet

New Residence
How many flights of stairs from ground floor to your new residence?
What type of stairs?
If there is an elevator, how long is the walk from your apt. to the elevator? feet
From the elevator to the door at the lobby? feet
From the building to the truck? feet

Accessibility
Is truck parking accessible at the on-load?
What are possible obstacles?
Street Name?
Do you need parking permits?
SPECIFIC INFORMATION
A room to room list of all items being moved:
In order to give our Move Coordinators the most detailed account of your move please fill out the following itemized list. Put the number of items you will be moving in the box next to the item. If there are any miscellaneous items not on the list please include them in the "other" field at the bottom of each room.
How many rooms do you have?
LIVING ROOM
TV, table model (10cf) Bookcase (2 cf)
Cabinet, curio (10cf) Chair, straight (5cf)
Chair, arm (10cf) Chair, rocker (12cf)
Chair, boudoir (10cf) Chair, overstuffed (25cf)
Chest, armoire (30cf) Sofa, loveseat (35cf)
Stereo (10cf) Sofa, 3 cushion (50cf)
TV, table model (10cf) Tables, coffee (5cf)
TV, console (15cf) Tables, end (5cf)
Rug, sm (3cf) Entertainment Center, sm (10cf)
Rug, lg (10cf) Entertainment Center, lg(40cf)
Spinet Piano (60cf) VCR (3cf)
Upright/Baby Grand Piano (70cf) Other
Grand Piano (80cf)
DINING ROOM
Dining Table (30cf) Hutch (top) (2cf)
Chair (5cf) Buffet (base) (30cf)
Server (15cf) Cabinet, corner (2cf)
Rug, sm (3cf) Other 
Rug, lg (10cf)
BEDROOM / NURSERY
Bed, single (40 cubic feet) Chest, armoire (30cf)
Bed, std/dbl (60cf) Dresser, single (30cf)
Bed, queen (65cf) Dresser, double (40cf)
Bed, king (70cf) Dresser, triple (50cf)
Bed, youth (30cf) Wardrobe, sm (20cf)
Bed, bunk (set of 2) (70cf) Wardrobe, lg (40cf)
Chair, boudoir (10cf) Desk, sm/winthrop (22cf)
Rug, sm (3cf) Table, child’s (5cf)
Rug, lg (10cf) Chest, toy (5cf)
Night table (10cf) Crib, baby (10cf)
Bookshelves (sectional) (5cf) Other 
APPLIANCES / KITCHEN
Aircond./window (20cf) Chair (5cf)
Range (20cf) Microwave oven (10cf)
Refrigerator (6sq ft or less)(30cf) Breakfast Table (10cf)
Refrigerator (7sq ft or less)(45cf) Serving cart (15cf)
Refrigerator(11sq ft +)(60cf) Ironing Board (2cf)
Freezer (10sq ft or less)(30cf) Vacuum Cleaner (5cf)
Freezer (10-15)(45cf) Washing Machine (25cf)
Freezer (16cu ft or over)(60cf) Dryer (25 cf)
Dishwasher (20 cf) Other 
OUTDOOR / PATIO / PORCH / MISC
BBQ Grill (10cf) Desk, office (10cf)
Chair, aluminum/plastic (1cf) Trash can (10cf)
Chair, metal (3cf) Filing cabinet, 2dr (10cf)
Chair, wood (5cf) Filing cabinet, 4dr (10cf)
Swing Set (35cf) Wagon, child’s (10cf)
Bicycle (10cf) Golf bag (10cf)
Pool Table (40cf) Work Bench (20cf)
Suitcase (10cf) Power Tool (20cf)
Other 
PACKING BOXES
Dish Barrel (5.2cf) X-large ctn (6.1cf)
Book (1.5cf) Wardrobe ctn (10cf)
Med ctn (3.1cf) Picture/Mirror ctn (10cf)
Large ctn (4.5cf) Other 
PREPARATION

Will you be packed & ready to go?
Required packing service:
Do you require packing supplies ?
ADDITIONAL SERVICES
Will you be shipping a vehicle? Year Make Model
Will you be shipping an SUV/truck? Year Make Model
Will any items require disassembly/assembly or any special handling ?
VALUATION COVERAGE
What type of coverage would you prefer?
What deductible do you want?
ADDITIONAL INFORMATION
Any additional information that will help us make your move as smooth and trouble free as possible: Thank you for your time and providing us with information on your move. We will contact you within 48 hours.
 
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