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DH Moving Residential Survey Form:

Please be SURE to fill out accurately ALL FIELDS before submitting:

** Please note that the following survey and inventory are only used to give you an IDEA of what your move may entail and cost. This is by no means an adequate substitute for an " on-site " visit by a DH Moving & Storage representative.

Type of Move: Residential
Dates of Service  
Packing (DATE)
Loading from Origin (DATE)
Unloading at Destination (DATE)
Submitted By: (NAME)
Company:(If a Commercial Move)
Contact Info  
Home Phone
E-Mail address
Cell Phone

Work Phone

Other
Preferred contact method
How did you hear about DH Moving?
 
Origin Info (moving from)  
Address
Line 1
Line 2
City
State
Zip Code
Destination Info (moving to)  
Address
Line 1
Line 2
City
State
Zip Code
Elevator at Origin Elevator at Destination
Steps at Origin Steps at destination
Unusual Factors at Origin Please Explain
Unusual Factors at Destination Please Explain
Moving From
Moving To
Inventory of Items to be Moved by D H Moving & Storage Inc.
Living Room: # of pieces   # of pieces
Bookcase Entertainment Unit
Bench Rugs: Large w/Pad
Computer Desk Rugs: Small w/Pad
Curio Cabinet Sofas: Loveseat
Chair: Arm Sofas: 3 Cushion
Chair: Rocker Sectional Pieces
Chair: Overstuffed Tables: Drop Lf / Occsnl
Cedar Chest Coffee Table
Desk: Secretary End Table
Estimated number of boxes  
Other
Other
Dining Room # of Pieces # of Pieces
Buffet (Base) Dining Table
Hutch (Top) Dining Chair
Corner Cabinet Server
Rugs: Large w/Pad Rugs: Small w/Pad
Estimated number of boxes  
Other
Other

Kitchen

# of Pieces   # of Pieces
Kitchen Chairs Serving Cart
Kitchen Table Utility Cabinet
Child High Chair Stool
Microwave Stand
Estimated number of boxes  
Other
Other

Appliances

# of Pieces   # of Pieces
Air Conditioner Dehumidifier
Microwave Oven Freezer
Refrigerator Washing Machine
Vacuum Cleaner Dryer
Estimated number of boxes  
Other
Other
Electronics # of Pieces   # of Pieces
Stereo Component Television: Large
Stereo Console Television: Small
Stereo Cabinet Television: Big Screen
VCR, DVD, CD Television Stand
Computer / Printer
Estimated number of boxes  
Other

Major Bedrooms

# of Pieces   # of Pieces
Bed: Single / Twin Bed: Bunk Bed Set
Bed: Double / Standard Chair: Occasional
Bed: Queen Size Chair: Overstuffed
Bed: King Size Chair: Rocker
Cedar Chest Dresser: Single
Armoire / TV Unit Dresser: Double
Hamper / Basket Dresser: Triple
Night Stand Trunk / Footlocker
Rug: Large w / Pad Rug: Small w / Pad
Estimated number of boxes  
Other
Other
Childs Bedroom # of Pieces   # of Pieces
Youth Bed Rocking Chair
Toy Chest Crib
Changing Table
Estimated number of boxes  
Other
Other
Specialty Articles # of Pieces # of Pieces
Piano: Spinet Pool Table: Slate
Piano: Baby Grand Ping Pong Table
Hot Tub Swing Set
Riding Mower Exercise Machine
Boat / Canoe
Estimated number of boxes  
Other
Other
Porch / Outdoor # of Pieces   # of Pieces
BBQ Grill: Small Chairs
BBQ Grill: Large Ladder: Step
Garden Tools / Hose Ladder: Extension
Lawn Mower Leaf Sweeper
Child Gym Umbrella / Stand
Picnic Bench Wheelbarrow
Picnic Table
Estimated number of boxes  
Other
Other
Other
Garage / Shop /Misc. # of Pieces   # of Pieces
Bicycle: Child Office Desk
Bicycle: Adult Golf Club Set
Filing Cabinet: Two Drwr Metal Shelves
Filing Cabinet: Four Drwr Skis / Sled
Tires Suitcase
Trashcan Tool Chest: Small
Utility Table Tool Chest: Large
Work Bench Children's Toys / Wagon
Sewing Machine Cabinet Rugs: Large w / Pad
Rugs: Small w / Pad    
Estimated number of boxes  
Other Special Needs, Requests or Comments
For D H Moving & Storage use only Sub-Total
Cubic Feet  

Please note that the survey and inventory are only used to give you an IDEA of what your move may entail and cost. This is by no means an adequate substitute for an " on-site " visit by a D H Moving & Storage representative.


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