Smoke & Water Remediation Form

Smoke & Water Remediation Form

Please fill out the form below.
Contact/Pickup Name*

First NameLast Name
Phone Number - Pickup Contact Number*
(123) 456 7890
E-mail*
Piano Type, Length, and Monthly Storage Rates if the piano needs to be stored after remediation service*

Unsure, please attach a photo belowFull Size Upright, 48" - 60", $130.00/monthSpinet or Console, 36" - 44" $130.00/monthPetite Grand, Less than 5'0", $130.00/monthBaby Grand, 5'0"- 5'6", $130.00/monthGrand Piano, 5'7"- 5'11", $130.00/monthSmall Parlor Grand, 6'0"- 6'5", $136.00/monthLarge Parlor Grand, 6'6"- 6'11", $139.00/monthSmall Conservatory Grand, 7'0"- 7'5", $150.00/monthLarge Conservatory Grand, 7'6" - 7'11", $160.00/monthConcert Grand, 8'-9'6" $170.00/monthDigital Piano, $130.00/monthOrgan, $180.00/monthSquare Grand Piano, 7'0" $140.00/monthSquare Grand Piano, 8'0" $150.00/month
Attach a photo of your piano if you're unsure of the size.

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Make sure to take a photo that can help us determine the length. Cancelof
Is Your Piano a Player Piano?*
Do you need storage for your piano bench?*
Player Pianos are an additional $7/month

Upright Player, $0/per monthPlayer Grand, $7 additional/per month
Estimated Duration of Storage?*
How long will your piano be vacationing with us?
Piano Brand Name*
Steinway, Yamaha, Bechstein, Etc.
Serial # & Model
If you know the pianos serial # and model please submit.
Did Something Occur at Your Home and Insurance is Involved?*

YesNo
What company are you working with?
Please Select Services you're in need of.*

Piano PickupWater Damage RemediationSmoke Remediation, piano has black soot or ash on it?Fire Restoration, piano was damaged by smoke, peeling finish, water damage.TuningPiano Storage after service
How Soon do you Need Your Piano Picked up?*
Reserve your dates. Please advise.
Preferred Pickup Times*
Preferred Moving Date*

MonthDayYear
Mon - Sat., No Holidays
Pickup Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Steps at Pickup?*
Do you have any steps that the piano must go up or down?
Pickup Location, How many Steps?*
Steps Up/Down, Total Steps
At Pickup, Any Turns, Curves, or Landings?
Special scenario, please explain
Difficult or Special Circumstances (Dirt, Gravel, Steep Driveway etc.)
ie. broken leg, needs refinishing, was in a fire, sun damaged, etc.
Pictures of the Steps or Special Circumstances at Pickup & Delivery

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The more photos, the more accurate the quote Cancelof
Add any comments or concerns here.
ie. Needs refinishing, service, or cleaning.
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