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CUSTOMER INFO
Name
*
Email
*
Fax
Cell
Tel
Where did you hear about us?
LOCATION INFO
Date of Removal
Move from Address
What Floor
Ground Floor
1
2
3
4
5
Above 5
Lift or Stairs
None
Lift
Stairs
Move to Address
What Floor
Ground Floor
1
2
3
4
5
Above 5
Lift or Stairs
None
Lift
Stairs
ENTRANCE / LOUNGE
Entrance/Telephone Table:
Display/Wash Table:
Coffee Table:
Coffee Table Size
None
Small
Medium
Large
Side Tables
Upright Chairs
Arm Chairs
Arm Chairs(Bulky/Lazy Boy)
2 Seater Couch
3 Seater Couch
4 Seater Couch
Bookcase
Bookcase Size
None
Small
Medium
Large
Display Cabinet
Display Cabinet Size
None
Small
Medium
Large
Wall Unit
Wall Unit Size
None
Small
Medium
Large
TV Cabinet
TV Cabinet Size
None
Small
Medium
Large
TV Set
VCR MNet DVD
Kist
BEDROOMS
Single or ¾ Bed:
Double Bed:
Headboards:
Pedestals:
Dressing Table:
Chest of Drawers:
Upright Chair:
Arm Chair:
Clothes Horse:
Compactum:
Cot:
Wardrobe Gents:
Wardrobe Ladies:
DINING ROOM
Dining Table:
Dining Table Size:
None
Small
Medium
Large
Dining Room Chairs:
Sideboard
Sideboard Size:
None
Small
Medium
Large
Tea Trolley:
Hostess:
Welsh Dresser:
KITCHEN
Fridge:
Fridge Size:
None
Small
Medium
Large
Deep Freeze:
Deep Freeze Size:
None
Small
Medium
Large
Microwave:
Stove:
Tumble Dryer:
Washing Machine:
Dish Washer:
Kitchen Table:
Chairs:
Dust Bin:
STUDY
Desk:
Desk Size:
None
Small
Medium
Large
Office Chairs:
Credenza:
Computer / Printer:
Computer Stand:
Filing Cabinet:
Bookcase:
GARAGE
Workbench:
Workbench Size:
None
Small
Medium
Large
Tool Cupboard:
Toolbox:
Ladder:
Lawnmower:
Weedeater:
Garden Tools:
Machinery:
Machinery:
Machinery Please List:
OUTSIDE AREA
Braai:
Braai Size:
None
Small
Medium
Large
Garden Bench:
Garden Table: Rigid:
Garden Chairs: Rigid:
Garden Table: Fold Up:
Garden Chairs: Stack:
OTHER
Bar Stools:
Bicycles:
Carpets:
Chairs: Folding:
Dog Kennels:
Dog Kennels Size:
None
Small
Medium
Large
Dog Kennels:
Exercise Machine/Health Walker:
Fan:
Heater:
Hose Pipe:
Ironing Board:
Lamp:
Paintings/Mirrors:
Pot Plants: Small:
Pot Plants: Medium:
Pot Plants: Large:
Safe:
Safe Size:
None
Small
Medium
Large
Satellite Dish:
Tables: Folding:
Trunk/Trommel:
Umbrella (Garden):
Vacuum Cleaner:
Washing Basket:
Washing Rack/Stand:
Wheelbarrow:
PLEASE LIST ALL OTHER ITEMS
1.
2.
3.
4.
5.
6.
ANY DISMANTLING
1.
Yes
No
2.
Yes
No
3.
Yes
No
4.
Yes
No
Number of Suitcases:
Number of Boxes: