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Fill out as much of the form as you can. We will follow up with a phone call! We look forward to working with you in your upcoming move.

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 Email: * required
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Origin & Destination Information
ORIGIN (Moving FROM ?):
City:  
Zip: 		DESTINATION (Moving TO ?):
City:  
Zip: 		Approximate Moving Date:
Please Indicate the Quantity of Items to be Moved
LIVING ROOM :
Item Quantity
Sofa
Love seat
Hide-A-Bed
Sectional
Bookcases
Recliners, armchairs, rockers
Ottoman / Footstool
Coffee or End Table
Entertainment Center
Stereo
Portable TV 13-19 inch
Television 20-29 inch
Television 30-39 inch
Television 40+ inch
Stereo Components (Speakers, VCR's etc)
Floor Speakers
TV Stand
Lamps
Pictures & Paintings
Sofa Size Picture
Large Screen TV
Piano / Organ
Aquarium 10-20GAL
Aquarium 21-40GAL
Standing Mirror
 BEDROOM :
Item Quantity
King or Queen size Bed
Full Size Bed
Twin Size Bed
Bunk Bed
Water Bed
Bridge Bed
Head / Footboard
Dresser
Mirror (detached)
Chest of Drawers
Armoire / Wardrobe (empty)
Night Stand
Cedar Chest or Trunk
Crib or Changing Table
Linear Feet of Clothes on Rod
Small Desk

KITCHEN :
Item Quantity
Stove or Oven
Refrigerator or Freezer
Washer or Dryer
Microwave
Microwave Stand
Butcher Block

DINING ROOM :
Item Quantity
Dining or Kitchen Table
Dining Chairs or Bar Stools
China Cabinet (1 or 2 piece)
Buffet or Server

OFFICE :
Item Quantity
Office or Roll Top Desk
Desk Extension
Desk Chair
Credenza
Two Drawer Filing Cabinet
Four Drawer Filing Cabinet
Fire Proof Filing Cabinet
Conference Table
Drafting Table
Copier
Computer
2 Drawer Lateral File Cabinet
4 Drawer Lateral File Cabinet
Printer Stand
Gun Cabinet
Fireproof Gun Safe
MISC. :
Item Quantity
Boxes LESS THAN 50 lbs
Boxes MORE THAN 50 lbs
Glass Tops
Glass Shelves
Marble Tops
Area Rugs
Large Plants
Sewing Machines
Barbeque or Bicycle
Ironing Board or Vacuum
Bird Bath
Extension Ladder
Plant Stand
Step Ladder
Rolling Tool chest
Iron/Wood Table
Iron/Wood Chairs
Concrete Table
Concrete Bench
Pool Table
Vanity w/Mirror
Golf Clubs
Dorm Fridge
Push Mower
Riding Mower
Suitcases
Workbench
Yard Tools
Toy Box
Additional Comments :
How many feet from parking spot to unit or house?
ORIGIN:         < 100 ft.   > 100 ft.
DESTINATION: < 100 ft.   > 100 ft.

What type of building structure is it?
ORIGIN:       Apartment/Condo     House
         Other Building Type:
DESTINATION: Apartment/Condo   House
         Other Building Type:
Please mark all that apply at each location.
ORIGIN: Are there stairs?  
     How many flights of stairs?  
     Are there elevators?  
DESTINATION:Are there stairs?   
      How many flights of stairs?  
      Are there elevators?  

NOTES:

    Disassembly and re-assembly available upon request for an additional fee depending on items.

    Minimum move price is $97.00 (2 items or less, within 5 mile radius, ground level/access within 100' (feet) at each location.

    Prices may vary due to mileage and moving conditions.

    Chaparral Moving office will call to verify terms and conditions.

    Loaner Boxes are available for your convenience.