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Name *

First Name

Last Name

Preferred Moving Date *

MM

DD

YYYY

Pick-Up Location *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Drop-Off Location *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Disassembly and Reassembly of Furniture (Optional)

Would you like assistance with disassembly and reassembly of furniture?

Yes

No

Building Requirements

Does your building require Certificate of Insurance (COI)?

Yes

No