Baya Intake Form

Baya Moving Estimate Form

Baya Inc. Moving and Storage Company.
Please fill out the form for a free estimate.
Full Name*
E-mail*
Phone Number*
Referred By*

CaseworkerFlyerTruckFriendOther
If referred by other - please explain:

Currently In Storage? (Skip if NO)

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If we are picking up from a storage facility, what is the name?
What is the storage facility address?
What is the storage facility phone?
How many units and what are the unit numbers?
What is the size of your units?
Is your rent at the storage facility paid?
When was the last visit to your storage unit?

On Public Assistance? (Skip if NO)

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Caseworker Name:
Case #
Case Worker Email:
example@example.com
Caseworker Phone:
Center #

Delivery and Furniture Grants

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Does either building require special delivery insurance?*

YesNo
Pickup address requirements:
Drop-off address requirements:
Specific Pickup Times (If Applicable)
Specific Delivery Times (If Applicable)
Are you on Public Assistance and interested in our new furniture program?

YesNo
Send Furniture Information via

PhoneFaxEmail

Inventory

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Please provide an accurate inventory of your possessions. Failure to provide accurate information will result in an inaccurate quote, and service will be denied.
Must Agree Before Continuing*

All information I am providing is accurate.

Bedroom Items - Inventory

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Twin Mattress
Twin Box Spring
Full Mattress
Full Box Spring
Queen Mattress
Queen Box Spring
King Mattress
King Box Spring
Bed Frame
Headboard
Footboard
Chest Of Drawers
Wardrobe
Dresser
Armoire
Mirror
Nightstand
Platform Bed
Trunk
Bunk Bed

Living Room Items - Inventory

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Sofa
Loveseat
Armchair
Sectional
Futon
Sofa Bed
Wall Unit
Recliner
Bookshelf
DVD Rack
Coffee Table
End Table
Bar
Bar Stools
Ottoman

Kitchen / Dining Items Inventory

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Table
Chairs
Dining Table
Dining Chairs
Folding Table
Folding Chairs
Refrigerator
Freezer
Microwave
Microwave Cart
Kitchen Island
Stove
Kitchen Cabinet
China Cabinet
Dishwasher

Kids Items - Inventory

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Crib
High Chair
Playpen
Toy Car
Toy Chest
Stroller
Bassinet
Changing Table

Exercise Items - Inventory

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Weights
Treadmill
Bench
Bicycle

Office Items - Inventory

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Desk
Desk Chair
File Cabinet

Electronics - Inventory

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Surround Sound
Small LCD up to 32"
Medium LCD up to 42"
Large LCD over 42"
Large Box TV over 50"
Small Box TV under 50"
Floor Model TV
TV Stand

Miscellaneous - Inventory

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Bathroom Rack
Grandfather Clock
Large Pictures / Mirrors
Artificial Floor Plants
Large / Small Pet Cage
Large Fish Tank
Fish Tank Stand
Fan
Large Air Conditioner
Small Air Conditioner
Washer
Dryer
Vacuum Cleaner
Electric Heater
Sewing Machine
Ironing Board
Area Rug
Shopping Cart
Barrel
Crate
Bin
Bags
Boxes
Suitcase

Disassembly and assembly of furniture are not automatically included. If you need furniture assembled or disassembled please comment below.
Disassembly and assembly comment (if applicable):
Final Comment (if applicable):
Lastly, How did you hear from us?*

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