LifeLine Movers & Cleaners Service Request Form
Complete this form so we can get an accurate depiction of your move. We service DC, MD, VA and countrywide. Telephone/Text: 202-567-1576. Email: lifelinedmv@outlook.com
Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Date of Move
-
Month
-
Day
Year
Date
Time of Move - Please select up to three potential START times.
8:00am
9:00am
10:00am
11:00am
Noon
1:00pm
2:00pm
3:00pm
4:00pm
5:00pm
After 5:00pm (additional charge)
Service Requested (Select all that apply)
Load
Unload
Packing/Unpacking (additional fee)
Assembly/Disassembly (additional fee)
PICK UP/LOAD Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select all the applies about PICK UP address
Elevator
Freight/Service Elevator
Stairs (additional fee for more than 2 flights of stairs
Ramp
Loading Dock
Long Distance Walk from pick up to loading zone (additional fee)
DROP OFF/UNLOAD Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select all the applies about DROP OFF address
Elevator
Freight/Service Elevator
Stairs (additional fee for more than 2 flights of stairs
Ramp
Loading Dock
Long Distance Walk from pick up to loading zone (additional fee)
List ALL items to be moved. Items not listed will NOT be moved or an additional charge will be applied upon move.
Are there any items over 100 pounds (Additional fee)?
Yes
No
Number of Boxes/Totes
Any additional information to help our movers
How did you find out about us?
Submit
Should be Empty: