NOTE: Any information provided below will be used towards providing you with an accurate estimate and will not be shared with any promotional or advertising companies or their affiliates. The only response you should receive will be your estimated costs for relocation services.

Est. moving date mm / dd/ yyyy
* Name
* E-mail:
* Home Phone Cell Phone
  Moving From:   Moving To:
* City * City
* Province/State: * Province/State:
       

Are there any Stairs inside or outside your house?

 Yes No
If yes...How Many? (please give an accurate count)

Is it more than 25 feet from your front door to the street?

 Yes No
If yes...How Many Feet? (pace out 2 strides = 5ft)
Would you like us to perform any Packing services? Yes No
If yes...Which rooms would you like packed?
LIVING ROOM
ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES
Bookshelves (per section) Arm Chair Rocking Chair (wood)
Overstuffed Chair Straight Chair Desk (small)
Fireplace Equipment Floor Lamp Foot Stool/Ottoman
Grandfather Clock Grandmother Clock Hall Tree Rack
Hide-A-Bed Magazine Rack Organ
Piano, Apartment
(includes bench)		 Piano (Baby Grand) Upright Piano
(includes bench)
Radio Cassette Recorder Rug or Pad (large) Rug or Pad (small)
Sofa, Loveseat Sofa, 3 Cushion Speakers (ea.)
Stereo Cabinet Stereo Components (ea.) Coffee, End or Nesting Tables
Television, Console Television
(Table-top with Stand)		 VCR/DVD Player 
Wall Unit        
DINING ROOM
ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES
Breakfront (One Piece) Buffet (Bottom) Dining Chair
Corner Cabinet Hutch (Top) Rug or Pad (Large)
Rug or Pad (Small) Server/Tea Cart Dinette Table
Extension Table        
BEDROOM(S)
ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES
Single Bed Double Bed King/Queen/Water Bed
Bunk Beds (set of 2) Cedar Chest Chair
Desk (Small) Single Dresser Double Dresser
Triple Dresser Night Table(s) Rug or Pad (Large)
Rug or Pad (Small) T.V. (Table-top) with Stand Vanity (Includes Bench)
Wardrobe (Wood) Bookshelves (Sectional) Toy Chest
NURSERY
ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES
Bathinette Child's Chair Chest of Drawers
Toy Chest Crib Night Table
Playpen Rug or Pad (Large) Rug or Pad (Small)
KITCHEN
ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES
Buffet Chair (Straight) Chair (High)
Ironing Board Stool Table (4' or less)
Table (5' to 6') Television (Portable)    
APPLIANCES
ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES
Air Conditioner Dehumidifier Dishwasher
Dryer Floor Polisher Freezer (10 cu. or Less)
Freezer (11 to 15 cu.) Freezer (16 cu. and over) Humidifier
Microwave Oven Range Refrigerator (6 cu. or Less)
Refrigerator (7 to 10 cu.) Refrigerator (11 cu. and over) Sewing Machine (Cabinet)
Sewing Maching (Portable) Trash Compactor Vacuum Cleaner
Washer        
PORCH, OUTDOOR FURNITURE OR EQUIPMENT
ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES
Barbecue (Charcoal) Barbecue (Gas) Chaise Lounge
Garden Hose Extension Ladder Step Ladder
Lawn Chair Lawn Table Lawn Umbrella
Lawn Mower (Electric) Lawn Mower (Gas) Lawn Mower
(Riding 1 to 7 hp)
Outboard Motor (25 hp) Outdoor Swing Picnic Table
Snow Blower
(1 to 7 hp)		 Garden Tools (per 6) Wading Pool (Child's)
Wheel Barrow        
Miscellaneous
ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES
Ash/Trash Can Bicycle Filing Cabinet (2 dr)
Filing Cabinet (4 dr) Baby Carriage Clothes Hamper
Computer/Keyboard/
Monitor/Printer		 Computer Table (Large) Computer Table (Small)
Office Desk Exercise Bike Fan
Folding Chair/Table (ea) Golf Bag/Skis/Sled Gun Cabinet
Gas/Electric Heater Ping Pong Table Plant Stand
Pool Table (4 x 8') Pool Table (Slate) Power Saw (Floor Model)
Rowing Machine Metal Shelves Stairmaster
Stroller Suitcase Tire
Tire (Mounted) Tool Chest (Large) Tool Chest (Small)
Treadmill Steamer Trunk Typewriter
Child's Vehicle Work Bench Workmate
CONTAINERS
ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES		 ARTICLE NO. OF
PIECES
Appliance/Tea 2 cu. Carton 2 cu. Carton (Books)
4 cu. Carton 5 cu. Carton 6 cu. Carton
China Carton Gun Carton Lampshade Carton
Single Mattress Double Mattress King/Queen Mattress
Crib Small Mirror Large Mirror
Wardrobe Carton        
 
Please tell us how you heard about Qwest Haven Relocations:



Have you previously spoken to a Qwest Haven Relocations Move Consultant? Yes No

If yes, what was the consultant's name?


OTHER
(Please list any items you were unable to locate above)


Total Weight (in lbs)



 

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