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Estimated move date: N/A Jan Feb March Apr May June July Aug Sep Oct Nov Dec N/A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 N/A 2002 2003 2004 2005 2006 Moving From:     Moving To: Address: Address: City : City : State: State: Zip: Zip: Size of residence: N/A House Apartment # of Bedrooms # of Rooms Flights of Stairs Major Appliances Size of residence: N/A House Apartment # of Bedrooms # of Rooms Flights of Stairs         Will Temporary Storage be needed? Yes No Will destination residence be ready by time of move? Yes No

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     Comments * indicate any special care items