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Personal Details
First Name:
Last Name:
Mobile:
Home Phone:
E-mail:
Fax:

Pickup Address

Flat No:
Floor No:
Street No:		Select any that apply:
Address:		Easy Access
City:		Difficult Access

Services

Overseas Move

Local Move

Storage

Overseas Move via storage

Local Move via storage

Delivery Address

Flat No:		Select any that apply:
Floor No:		Easy Access
Street No:		Difficult Access
Address:
City:
State:	Select State AL Alabama AK Alaska AZ Arizona AR Arkansas CA California CO Colorado CT Connecticut DE Delaware DC District of Columbia FL Florida GA Georgia HI Hawaii ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MD Maryland MA Massachusetts MI Michigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NH New Hampshire NJ New Jersey NM New Mexico NY New York NC North Carolina ND North Dakota OH Ohio OK Oklahoma OR Oregon PA Pennsylvania RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VA Virginia WA Washington WV West Virginia WI Wisconsin WY Wyoming
Postcode
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Relocation Details

Pickup Date
Delivery date
Storage Required	For Number of months

Bedroom 1

Item	Qty	Item	Qty
Single Bed		Mirror
Double Bed		Rug
Divan Bed		Lamp
Chair		Curtain & Blinds
Bedside Table		Bookcase
Dressing Table		Wardrobe Armoire
Chest of Drawers
Small items est. to be packed by you (no.of cartons)		Small items est. to be packed by Columbia (no.of cartons)

Bedroom 2

Item	Qty	Item	Qty
Single Bed		Mirror
Double Bed		Rug
Divan Bed		Lamp
Chair		Curtain & Blinds
Bedside Table		Bookcase
Dressing Table		Wardrobe Armoire
Chest of Drawers
Small items est. to be packed by you (no.of cartons)		Small items est. to be packed by Columbia (no.of cartons)

Bedroom 3

Item	Qty	Item	Qty
Single Bed		Mirror
Double Bed		Rug
Divan Bed		Lamp
Chair		Curtain & Blinds
Bedside Table		Bookcase
Dressing Table		Wardrobe Armoire
Chest of Drawers
Small items est. to be packed by you (no.of cartons)		Small items est. to be packed by Columbia (no.of cartons)

Bedroom 4

Item	Qty	Item	Qty
Single Bed		Mirror
Double Bed		Rug
Divan Bed		Lamp
Chair		Curtain & Blinds
Bedside Table		Bookcase
Dressing Table		Wardrobe Armoire
Chest of Drawers
Small items est. to be packed by you (no.of cartons)		Small items est. to be packed by Columbia (no.of cartons)

Dining Room Items

Item	Qty	Item	Qty
Table		Curtains & Blinds
Chair		Mirror
China Cabinet		Table Linens
Bugget/sideboard		Dining Room Tables
Hostess Trolley		Pictures & Paintings
Lamp		Clock
Rug & Carpets		Ornaments
Writing Bureau/desk		Crystal Cabinet
Small items est. to be packed by you (no.of cartons)		Small items est. to be packed by Columbia (no.of cartons)

Living Room

Item	Qty	Item	Qty
Air Conditioner		Buffet
Lounge 2 Seater		Lamp
Lounge Suite		Tables
Lounge 3 Seater		Pictures & Paintings
Rugs & Carpets		Curtains & Blinds
TV Antenna		Bookcase Wall Unit
TV Stand		Upright Piano
Writing Bureau/desk		Piano G
Video Recorder		Clock
Radio		Magazine Tidy
Hi-fi System		Mirror
Record Player		Stereo Cabinet
CD Player		TV Cabinet
Speakers		Stool
DVD Player
Small items est. to be packed by you (no.of cartons)		Small items est. to be packed by Columbia (no.of cartons)

Kitchen Items

Item	Qty	Item	Qty
Table		Stool
Chairs		Vegetable Tidy
Freezer		Iron
Refrigerator		Ironing Board
Dishwasher		Rubbish Bin
Microwave		Tumble Dryer
Washing Machine		Oven
Small items est. to be packed by you (no.of cartons)		Small items est. to be packed by Columbia (no.of cartons)

Bathroom Items

Item	Qty	Item	Qty
Toiletries		Laundry Basket
Rugs Toilet Covers		Hairdryer
Cabinet Shelves		Mirror
Small items est. to be packed by you (no.of cartons)		Small items est. to be packed by Columbia (no.of cartons)

Family Study Room

Item	Qty	Item	Qty
Armchair		Computer Cabinet
Bookcase (large)		Filing Cabinet
Bookcase (medium)		Desk
Bookshelf		T.V small
Chairs		T.V Antenna
Bins		Video
Computer		Stereo
Computer printer		Cameras
Computer supplies		Projector
Records/Tapes		Sofa
Fax		Rugs & Carpets
Typewriter		Lamps
Picture and Paintings		Tables
Curtains & Blinds		Grand Father Clock
Small items est. to be packed by you (no.of cartons)		Small items est. to be packed by Columbia (no.of cartons)

Basement & Garage

Item	Qty	Item	Qty
Toolbox		BBQ
Bicycle		Bins
Antenna		Luggage/Trunks
Chairs		Workmench
Scooter		Hand Tools
Drums		Power Tools
Fold Chair		Plant Holders
Garden Hose		Pot Plants - Large
Garden Seat,		Pot Plants - Small
Trampoline - Dismantled		Table - Outdoor
Sewing Machine		Xmas Tree/Decorations
Fireplace equipment		Toys And Games
Billard Table		Beach Umbrella
Golf Bag/Buggy		Table Tennis Table
Skis		cellaneous Boxes
Small items est. to be packed by you (no.of cartons)		Small items est. to be packed by Columbia (no.of cartons)

Vehicles

Car Saloon

Car Jeep

Motorcycle

Boat

Other

Pets

Dogs
Number:		Type:
Dimensions:	Tail-nose: cm
	Ear-floor: cm
Cats
Number:		Type:
Dimensions:	Tail-nose: cm
	Ear-floor: cm
Other
Do you have a cage for you pets?		Yes
		No
From which airport is more convenient to receive your pet?

Packing Services

Will you need professional packing from our company?	Yes	No
You prefer to supply you the necessary packing materials and make the packing by yourself?	Yes	No

Marine Insurance Services

Estimated Insurance value
Insurance options:
All Risk Insurance
Total Loss Insurance
No Insurance
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