Name Address Delivery Address Approx Date of Move Phone Fax Email Insurance Insurance Amount House Type Kitchen - Cabinet Kitchen - Dishwasher Kitchen - Dresser Kitchen - Freezer Kitchen - Fridge Kitchen - Highchair Kitchen - Chair Kitchen - Table Kitchen - Microwave Oven Kitchen - Stool Kitchen - Tidy Bin Kitchen - Cartons (Standard) Kitchen - Cartons (Books) Kitchen - Cartons (Pictures) Kitchen - 1st Extra Item (Please include description and quantity) Kitchen - 2nd Extra Item (Please include description and quantity) Kitchen - 3rd Extra Item (Please include description and quantity) Dining Room - Air Cooler Dining Room - Billiard Table Dining Room - Bookcase Dining Room - Buffet / Sideboard Dining Room - Capet / Mats Dining Room - Carver Chair Dining Room - Chair Other Dining Room - Cocktail Cabinet Dining Room - China Cabinet Dining Room - Dining Chairs Dining Room - Dining Table Dining Room - Fan Dining Room - Stereo Dining Room - Traymobile Dining Room - Cartons (Standard) Dining Room - Cartons (Books) Dining Room - (Pictures) Dining Room - 1st Extra Item (Please include description and quantity) Dining Room - 2nd Extra Item (Please include description and quantity) Dining Room - 3rd Extra Item (Please include description and quantity) Hall - Coat Rack Hall - Dropside Table Hall - Glory Box Hall - Grandfather Clock Hall - Hall Stand Hall - Table Hall - Pedestal Hall - Phone Table Hall - Cartons (Standard) Hall - Cartons (Books) Hall - (Pictures) Hall - 1st Extra Item (Please include description and quantity) Hall - 2nd Extra Item (Please include description and quantity) Hall - 3rd Extra Item (Please include description and quantity) Bedroom - King Size Bed Bedroom - Queen Size Bed Bedroom - Double Bed Bedroom - Single Bed Bedroom - Folding Bed Bedroom - Water Bed Bedroom - Bedside Table Bedroom - Bookcase Bedroom - Bouncinette Bedroom- Box or Chest Bedroom - Carpet or Lino Bedroom - Chair Bedroom - Change Table Bedroom - Chest of Drawers Bedroom - Cot Bedroom - Cupboard Bedroom - Desk Bedroom - Divan / Settee Bedroom - Dressing Table Bedroom - Headboard Bedroom - Lamp Bedroom - Lowchair Bedroom - Lowboy Bedroom - Mirror Bedroom - Playpen Bedroom - Pram Bedroom - Rocking Chair Bedroom - Stool Bedroom - Stroller Bedroom - Suitcase Bedroom - Trunk Bedroom - Tallboy Bedroom - TV Bedroom - Wardrobe Bedroom - Cartons (Standard) Bedroom - Cartons (Books) Bedroom - Cartons (Pictures) Bedroom - Port-A-Robes Bedroom -1st Extra Item (Please include description and quantity) Bedroom - 2nd Extra Item (Please include description and quantity) Bedroom -3rd Extra Item (Please include description and quantity) Lounge - 3 Seater Lounge Lounge - 2 Seater Lounge Lounge - Arm Chair Lounge - Bar Lounge - Bar Fridge Lounge - Bean Bag Lounge - Bookcase Lounge - Bureau Lounge - Candle Stand Lounge - Carpet / Rug Lounge - CD Stacker Lounge - Chair (Other) Lounge - China Cabinet Lounge - Coffee Table Lounge - Desk Lounge - Divan/Settee Lounge - Entertainment Unit Lounge - Heater Lounge - Lampstand Lounge - Lounge Suite Lounge - Magazine Rack Lounge - Occasional Table Lounge - Organ Lounge - Piano Lounge - Pouffes Lounge - Radiogram Lounge - Recliner Lounge - Rugs Lounge - Smoker Stand Lounge - Speakers Lounge - Standard Lamp Lounge - Stereo Lounge - Stereo Cabinet Lounge - TV Large Lounge - TV Small Lounge - VCR Lounge - Wall Unit Lounge - Wine Rack Lounge - Cartons (Standard) Lounge - Cartons (Books) Lounge Cartons (Pictures) Lounge - Cartons (Lamp Shades) Lounge - 1st Extra Item (Please include description and quantity) Lounge - 2nd Extra Item (Please include description and quantity) Lounge - 3rd Extra Item (Please include description and quantity) Study - Bookcase Large Study Bookcase Small Study - Chair Study - Computer Study - Cupboard Study - Desk Study - Drawing Board Study - Filie Cabinet (3 Draws) Study - Filie Cabinet (2 Draws) Study - Filie Cabinet (1 Draws) Study - Shelving Study - Stool Study - Cartons (Standard) Study - 1st Extra Item (Please include description and quantity) Study - Cartons (Pictures) Study - 1st Extra Item (Please include description and quantity) Study - 2nd Extra Item (Please include description and quantity) Study - 3rd Extra Item (Please include description and quantity) Laundry - Airer Laundry - Broom / Mops / Etc Laundry - Cabinet (Small) Laundry - Clothes Dyer Laundry - Cupboard Laundry - Ironing Board Laundry - Laundry Basket Laundry - Laundry Trolley Laundry - Linen Basket Laundry - Sewing Machine Laundry - Sewing Machine Cabinet Laundry - Stool Laundry - Table Laundry - Washing Machine Laundry - Cartons (Standard) Laundry - Cartons (Books) Laundry - Cartons (Pictures) Laundry - 1st Extra Item (Please include description and quantity) Laundry - 2nd Extra Item (Please include description and quantity) Laundry - 3rd Extra Item (Please include description and quantity) Outside / Sundries - Antenna Outside / Sundries - Barbeque Outside / Sundries - Basketball Hoop Outside / Sundries - Beach Umbrella Outside / Sundries - Camping Gear Outside / Sundries - Car Ramps Outside / Sundries - Card Table Outside / Sundries - Child Chairs Outside / Sundries - Chairs Outside / Sundries - Child's Table Outside / Sundries - Compost Bin Outside / Sundries - Cupboard Outside / Sundries - Doll House Outside / Sundries - Drums Outside / Sundries - Esky Outside / Sundries - Fish Basket Outside / Sundries - Fish Tank Outside / Sundries - Fishing Rods Outside / Sundries - Folding Chair Outside / Sundries - Folding Lounge Outside / Sundries - Garden Roller Outside / Sundries - Garden Shed Outside / Sundries - Garden Seat Outside / Sundries - Garden Setting Outside / Sundries - Garden Tools Outside / Sundries - Golf Bag Outside / Sundries - Golf Buggy Outside / Sundries - Guitar Outside / Sundries - Gym Set Outside / Sundries - Kennel Outside / Sundries - Ladder Outside / Sundries - Mower & Catcher Outside / Sundries - Outdoor Setting Outside / Sundries - Pedal Car Outside / Sundries - Playgym Outside / Sundries - Pot Plants Outside / Sundries - Scooter Outside / Sundries - Shelves Outside / Sundries - Skis Outside / Sundries - Swing Set (Dismantled) Outside / Sundries - 2nd Extra Item (Please include description and quantity) Outside / Sundries - Trampoline Outside / Sundries - Trike Outside / Sundries - Table Outside / Sundries - Welder Outside / Sundries - Welder Outside / Sundries - WheelBarrow Outside / Sundries - Windsurfer Outside / Sundries - Workbench Outside / Sundries - Cartons (Standard) Outside / Sundries - Cartons (Books) Outside / Sundries - Cartons (Pictures) Outside / Sundries - Port-a-Robe Outside / Sundries - Bird Cage & Stand Outside / Sundries - Horse Outside / Sundries - Surf Board Outside / Sundries - Whipper Snipper Outside / Sundries - 1st Extra Item (Please include description and quantity) Outside / Sundries - 2nd Extra Item (Please include description and quantity) Outside / Sundries - 3rd Extra Item (Please include description and quantity)