Name *
E-mail *
Enter Current Address Bellow
Current Street *
Current City *
Current State *
Current Zip Code *
Home Size * -- Please select one -- 1 Bed Room 2 Bed Room 3 Bed Room 4 Bed Room Larger
Elevator Present? * -- Please select one -- Yes No
Number of stair steps to door? *
What is the distance from the street to the front door? *
Enter Destination Address Bellow
New Street *
New City *
New State *
New Zip Code *
Home Size * -- Please select one -- 1 Bed Room 2 Bed Room 3 Bed Room 4 Bed Room Larger
Elevator Present * -- Please select one -- Yes No
Number of stair steps to door? *
What is the distance from the street to the front door? *
Please enter the number of type of furnature in the boxes bellow
Air Conditioner
Credenza
Piano Bench
Armoire
Curio
Piano, Spinet
Large Armoire
Day Bed
Piano, Upright/Baby Grand
Bar
End Table
Picture 2x2 ft. or less
Bar Stool
Entertainment Center
Picture 2x2 ft. or more
Bookcase
Futon
Rugs, Small
Book Shelf 2-3 Shelf
Grandfather Clock
Rugs, Large
Book Shelf 3-6 shelf
Lamp, Floor
Metal Shelves
Chair, Straight Back
Lounge
Sofa, 3 Cushion
Chair, Overstuffed
Loveseat
Sectional Sofa(# of sect)
Coffee Table
Ottoman
Sofa Chair
Couch
Piano, Grand
Speaker
Table, Sm. Glass Top
TV Floor Model
Stereo
Table, Lg. Glass Top
TV, Projection
Table Lamp
TV
VCR/DVD/AV Components
Table, Large
TV, Flat (high-end)
Wall Unit P/Piece
Table, Small
TV Stand
Wall Hangings
Buffet
Dining Chair
Hutch Top
Buffet Base
Dining Table
Server
Chandelier
Dining Table Glass Top
Baker's Rack
Kitchen Chair
Metro Shelving
Cabinet
Kitchen Table
Step Ladder
Foot Stool
Microwave Cart
Dishwasher
Microwave
Stove
Dryer
Refrigerator, sm.
Vacuum
Freezer
Refrigerator
Washer
Heater
Sewing Machine
Desk, Large
Fax Machine
Computer
Desk, Small
File Cabinet, 2 Drawers
Paper Shredder
Desk Chair
File Cabinet, 3-5 Drawers
Printer
Double Dresser
Baby Cribs
Single Bed
Cedar Chest
Dresser Single
Toy Chest
Chest
King Bed
Trunk
Chest of Drawers
Mirror, Large
Twin Bed
Child's Chair
Mirror, Small
Vanity
Night Table
Child's Table
Wardrobe, Cabinet
Double Bed
Queen Bed
Water Bed
Garden Tools, Lg
Shovels
Ladders
Golf Bag
Lawn Mowers
Toolboxes, Roll Away
Gym Equipment
Shelving
Toolboxes,Sm.
Bicycles
Outdoor Table
Swing Sets
Grill
Outdoor Chair
Umbrella
Lounge Chair
Plants
Fan
Ironing Board
Suitcase
Folding Chair
Playpen
Trash Can
Hampster
Sled
Work Bench
Please list any large items not listed on the above list in the space bellow
Do you need Rutledge Moving Systems to do your packing -- Please select one -- Yes No
Please complete the table listing below. All the boxes already boxed and/or boxes you plan to pack.
Small Box - (1.5 cu.ft.) 17"x13"x12" - Books/Records
Wardrobe Box Flat - (4.4 cu.ft.) 36"x21"x10" - Flat Chlothing
Medium Box - (3.1 cu.ft.) 18"x18"x16" - Miscellaneous
Wardrobe Box w/bar- (13.4 cu.ft.) 24"x21"x48" - Hanging
Large Box - (4.5 cu.ft.) 24"x18"x18" - Clothing
Legal tote w/Handle - (2.3 cu.ft.) 22"x15"x12" - Legal Files
Dishpack Box - (5.2 cu.ft.) 18"x18"x27" - Dishes/Glass
Letter tote w/Handle - (2.0 cu.ft.) 24"x12"x12" - Letter Files
Picture/Mirror Box - (2 pcs.) 40"x60"x4" - Adjustable
Chris will contact you as soon as possible. Thank you for taking the time to complete and submit this form.
Projected Moving Date *
Contact Phone Number *
