| Personal Details |
| Name + initials:* |
Mr Mrs/Ms |
| Telephone:* |
|
| Telephone: mobile/work: |
|
| Email address:* |
|
| Current address |
| Street + house no.* |
|
| Postal code* |
|
| Town or city* |
|
| Country* |
|
| Type of home |
|
| If it is an appartment, which floor? |
|
| Is there a lift? |
Yes No |
| Parking permit required? |
Yes No Unknown |
| Future address |
| Temporary storage of household effects |
Yes No |
| Address |
|
| Postal code |
|
| Town or city* |
|
| Country* |
|
| Type of home |
|
| If it is an appartment, which floor? |
|
| Is there a lift? |
Yes No |
| Parking permit required? |
Yes No Unknown |
| Dismantle/assemble furniture? |
Yes No Unknown |
| If so, which items |
|
| Do you want us to pack removal boxes? |
Yes No |
| If so, only breakables (glass/china) or everything? |
Breakables Everything |
| Do you want us to unpack the removal boxes? |
Yes No |
| If so, only breakables (glass/china) or everything? |
Breakables Everything |
| Payment for move |
private employer |
| If employer, name employer |
|
| Removal date* |
|
| Living room |
|
Two-seater sofa
Three-seater sofa
Side-tables
Bookcase
Sideboard
Armchair
Clock upright/hanging
Lamp
Plants
Coffee table
Painting/mirror
Secretaire
Stereo unit
Chair
Tv
Tv cabinet
Display cabinet
Carpet/rug
Wall unit per component
Number of boxes required (other)
Number of box required (breakables)
|
| Hall |
|
Hall cupboard
Wardrobe box
Hat-stand
Lamp
Plants
Painting/mirror
Number of boxes required (other)
Number of boxes required (breakables)
|
| Dining room |
|
Dining table
Cupboard
Small furniture
Lamp
Painting
Chair
Number of boxes required (other)
Number of boxes required (breakables)
|
| Kitchen |
|
Washing machine
Buffet
Kitchen table
Cooker
Refrigerator/freezer combined
Refrigerator/Deep-freeze
Microwave/oven
Chair
Number of boxes required (other)
Number of boxes required (breakables)
|
| Bedroom |
|
Single bed
Double bed
Double waterbed
Desk/dressing table
Wardrobe box
Desk of drawers
Lamp
Linen cupboard 2-door
Linen cupboard 3-door
Bedside table
Bed surrounds/ headboard
Chair
Tv/pc/stereo
Number of boxes required (other)
Number of boxes required (breakables)
|
| Bedroom2 |
|
Single bed
Double bed
Double waterbed
Desk/dressing table
Wardrobe box
Desk of drawers
Lamp
Linen cupboard 2-door
Linen cupboard 3-door
Bedside table
Bed surrounds/ headboard
Chair
Tv/pc/stereo
Number of boxes required (other)
Number of boxes required (breakables)
|
| Bedroom3 |
|
Single bed
Double bed
Double waterbed
Desk/dressing table
Wardrobe box
Desk of drawers
Lamp
Linen cupboard 2-door
Linen cupboard 3-door
Bedside table
Bed surrounds/ headboard
Chair
Tv/pc/stereo
Number of boxes required (other)
Number of boxes required (breakables)
|
| Bedroom4 |
|
Single bed
Double bed
Double waterbed
Desk/dressing table
Wardrobe box
Desk of drawers
Lamp
Linen cupboard 2-door
Linen cupboard 3-door
Bedside table
Bed surrounds/ headboard
Chair
Tv/pc/stereo
Number of boxes required (other)
Number of boxes required (breakables)
|
| Bathroom |
|
Spin dryer
Washing machine
Cupboard
Tumble dryer
Washstand
Number of boxes required (other)
Number of boxes required (breakables)
|
| Study |
|
Bookcase
Desk
Cupboard
Desk of drawers
Lamp
Guest bed
Pc/Tv
Shelves
Chair
Table
Sunbed
Number of boxes required (other)
Number of boxes required (breakables)
|
| Attic |
|
Camping equipment
Cupboard
Christmas decoration
Lamp
Ski box
Chair
Table
Number of boxes required (other)
Number of boxes required (breakables)
|
| Shed, garage, garden, hall |
|
Bicycle
Tools
Wood
Cupboard
Wheelbarrow
Ladder
Lamp
Plants
Pots
Shelves
Surfboard/cano
Garden bench
Garden furniture
Workbench
Number of boxes required (other)
Number of boxes required (breakables)
|
| Special items |
|
Antiques/Other (please specificy below)
Pc
Plants
Plasma tv
Grand piano + piano stool (please indicate below on which floor)
Piano + piano stool (please indicate below on which floor)
|
Here, please describe your antiques in more detail
|
Remarks/other items
|
|
|
