Moving U Customer Information Request Form
Customer Information:
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Move Details:
Move Date
*
-
Month
-
Day
Year
Date
Preferred Move Window
Please Select
Morning
Afternoon
Evening
Start/Pickup Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
End/Delivery Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Type
*
Please Select
House
Townhouse
Apartment
Home Size
*
Please Select
Studio
1 Bedroom
2 Bedrooms
3 Bedrooms
4+ Bedrooms
Stairs at Pickup?
*
Please Select
No stairs
1-2 flights
3+ flights
Stairs at Delivery?
*
Please Select
No stairs
1-2 flights
3+ flights
Access & Add-Ons:
Parking Restrictions or Permits Needed?
*
Please Select
Yes
No
Long Carry Distance (Far walk from truck to door)?
*
Please Select
Yes
No
Elevator?
*
Please Select
Yes
No
Disassembly/Reassembly Needed?
*
Please Select
Yes
No
Packing Services Needed?
*
Please Select
No packing
Partial packing
Full packing
Packing Materials Needed?
*
Please Select
Yes
No
Specialty Items (Check all the apply)
Piano
Safe
Large Appliances
Pool table
Other
Anything else we should know?
Submit
Should be Empty: