APPLICATION FORM

APPLICATION FORM
Name:

From:
Tel.(B):
Cell:
(Res):
Fax:
E-mail:
Enquiry Date:

DayMonthYear
Removal Date:

DayMonthYear
Removal Time:

:HourMinutesAM/PM Option

To:
Tel. (B):
Cell:
(Res):
Fax:
E-mail:
Delivery Date:

DayMonthYear
Delivery Time:

:HourMinutesAM/PM Option

KITCHEN:

Rows	Qty	Vaule
Stove
Fridge
Deep Freeze
Washing Machine
Tumble Dryer
Dishwasher
Cupboards
Kitchen Tables
Kitchen Chairs
Microwave
Vegetable Rack
Vacuum Cleaner
Polisher
Boxes
SUB-TOTAL

DINNING ROOM:

Rows	Qty	Value
Tables
Chairs
Sideboard
Room Divider
Tea Wagon
Carpets
Hostess
Welsh Drawer
Wall Unit
Bar Counter
Bar Stools
Service
Paintings
Boxes
SUB-TOTAL

BEDROOMS:

Rows	Qty	Value
Single Bed
Double Bed
H/Board (s)
H/Board (d)
Queensize Bed
W/robes (gents)
W/robes (ladies)
Pedestals
Kist
Dressing Table
Dressing Stool
Chest Drawers
Carpets
Gun Safe
Safe
Picture
Cot
Pram
Sewing Machine
Chival Mirror
Heater
Boxes
SUB-TOTAL

ODDMENTS:

Rows	Qty	Value
Wendy House
Bird Cage
Suitcases
Trunks
Dustbin
Golf Clubs
Prams
Swings
Dog Kennel
Windy Dryer
SUB-TOTAL

ENTRANCE HALL:

Rows	Qty	Value
Coat Hanger
Water Feature
Telephone Table
Paintings
Boxes
SUB-TOTAL

SERVANT'S QTRS:

Rows	Qty	Value
Bed
Wardobe
Table
Chairs
Chest Drawers
TV
Boxes
Other
SUB-TOTAL

LOUNGE:

Rows	Qty	Value
Settee (3-div)
Settee (2-div)
Coffee Table
Occasional Chairs
Chairs
Wall Units
Book Case
Display Cabinet
Decoder
TV
Standing Lamps
Carpet
DVD
Hi-Fi
Hi-Fi Stand
Piano
Grand Piano
Organ
G/Father Clock
Fish Tank
Airconditioner
Pouffe
Cocktail Cabinet
TV Cabinet
Painting
Rugs
Lazyboy
Boxes
Heater
SUB-TOTAL

GARAGE:

Rows	Qty	Value
Work Bench
Tool Box
Garden Tools
Ladders
Wheelbarrow
Lawnmower
Tool Cupboard
Machinery
Lathe
Planer
Drill Press
Welding Machine
Saw Bench
Bicycle
Motorbike
Boxes
SUB-TOTAL

GARDEN FURNITURE:

Rows	Qty	Value
Table
Chairs
Pot Plants
Pot Plants Stands
Braai
Boxes
SUB-TOTAL

GRAND TOTAL:
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Should be Empty: