Title: Mr. Mrs. Ms. First name: M.I.: Last name:
Telephone numbers:
Home: -   Work: - ext.

Fax number: -

Email address:

What kind of move is this? Household Commercial

Origin Address
Street Address Line1:
Street Address Line2:
City: State: AK AL AR AZ CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY Zip code:
Telephone: - ext.

Destination Address
Street Address Line1:
Street Address Line2:
City: State: AK AL AR AZ CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY Zip code:
Telephone: - ext.

Additional contacts (if any):

Additional stops (if any):

Origin and Destination Conditions

	Origin	Destination
Stairs	flights	flights
Elevator	Yes No	Yes No
Service Elevator	Yes No	Yes No
Elevator to basement	Yes No	Yes No
Elevator reservation arranged by shipper	Yes No	Yes No
Access to street	Yes No	Yes No
Long Carries (See Notes)	Yes No	Yes No

If there are long carries, please specify the distance: feet.

Do you require packing? Yes No
If yes, please elaborate:

Do you have large mirrors, glass, marble, or sculpture? Yes No
If yes, please specify the items and their dimensions below:

Do you require unpacking? Yes No

Do you require insurance? (See Notes) Yes No
If so, what is the declared value?
Does building management require insurance certificate?
     Origin: Yes No
     Destination: Yes No

Notes
- Long carries charges are applicable if either the origin or destination is not accessible within 75 feet by a 70-foot tractor-trailor.
- Insurance is $8.50 per $1,000 of declared value for replacement cost protection; $500.00 deductible.

We would like to know who referred you to Hudson. This information is for our records only and has no bearing on this estimate.
I was referred to Hudson by

Below is a list of articles. You will be asked to enter the number of articles of each type that you want moved. If you don't know the exact number right now, just estimate.

Living and Family Rooms

Article	Quantity		Article	Quantity		Article	Quantity
Bench, Piano			Fireplace Equip. 5-Pc.			Sofa, 4 Cushion
Bookcase			Foot Stool			Sofa, Hideabed
Bookshelves, Sec			Lamp, Floor or Pole			Sofa, Sectional, per Sec
Cabinet, Curio			Lamp, Table			Stereo Console
Chair, Arm or Straight			Piano, Spinet			Stereo Component
Chair, Occasional			Piano, Baby Grand/Upright			Table, Dropleaf/Occasional
Chair, Overstuffed			Piano, Parlor Grand			Table, End/Nest
Chair, Rocker			Rug, Large Roll or Pad			Television, Portable
Clock, Grandfather			Rug, Small Roll or Pad			Television, Table Model
Day Bed			Sofa, 2 Cushion			Television, Console
Entertainment Center			Sofa, 3 Cushion			Television, Big Screen

Dining Room

Article	Quantity		Article	Quantity		Article	Quantity
Bench, Harvest			Cabinet, Corner			Chair, Dining
Buffet, Base			Cabinet, China			Table, Dining
Buffet, Hutch			Cart, Serving

Kitchen

Article	Quantity		Article	Quantity
Chair, high			Table, Breakfast
Step Stool			Table, Small

Appliances

Article	Quantity		Article	Quantity		Article	Quantity
Air Conditioner, Window			Freezer, 11 to 15 CF			Refrigerator: Ice? Yes No
Dehumidifier			Freezer, 16 CF and over			10 CF or less
Dishwasher			Humidifier			11 CF and over
Dryer, Electric or Gas			Microwave			Washing Machine
Freezer, 10CF or less			Range, Electric or Gas

Bedroom

Article	Quantity		Article	Quantity		Article	Quantity
Bed, Single/Twin			Bookshelves, Sectional			Dresser, Single
Bed, Double/Full			Cedar Chest			Dresser, Double
Bed, Queen			Chair, Boudoir			Dresser, Triple
Bed, King			Chair, Rocker			Table, Night
Bed, Rollaway			Chaise Lounge			Wardrobe, Small
Bed, Bunk (Set of 2)			Desk, Small/Winthrop			Wardrobe, Large
Bench, Vanity			Dresser, Vanity			Waterbed Frame/Pedestal

Nursery

Article	Quantity		Article	Quantity		Article	Quantity
Baby Carriage			Changing Table			Stroller, Baby
Bassinet			Chest, Toy			Table, Child's
Bed, Youth			Crib
Chair, Child's			Dresser, Child's

Office/Study/Den

Article	Quantity		Article	Quantity		Article	Quantity
Chair, Swivel/Office			Desk, Hutch			File Cabinet, 4 Drawer
Computer PC/Monitor/Etc.			Desk, Secretary			File Cabinet, Lateral
Copier/Printer, Small			Fax Machine			Table, End
Copier/Printer, Medium			File Cabinet, 2 Drawer			Typewriter
Desk, Computer			File Cabinet, 3 Drawer

Exercise/Sports Equipment

Article	Quantity		Article	Quantity		Article	Quantity
Bicycle			Ping Pong Table			Treadmill/Step Machine
Camp Stove, Portable			Pool Table, Not Slate			Tricycle
Cooler, Small			Pool Table, Slate			Universal Gym Component
Cooler, Large			Sled			Weight Bench
Exercise Bike/Exercycle			Skis (Pair)
Golf Bag			Tent

Garage

Article	Quantity		Article	Quantity
Camper			Golf Cart, Motorized
Camper Shell			Motorcycle, Large
Canoe/Kayak/Scull			Snow Mobile

Please enter the make, model and year of any autos, pick-up trucks or other vehicles you want moved.

Porch/Outdoor Furn. & Equip.

Article	Quantity		Article	Quantity		Article	Quantity
Barbeque Grill			Ladder, 6 Ft Step			Outdoor Swingset
Bench, Picnic			Ladder, 8 Ft Metal			Rocker, Swing
Chair, Lawn			Ladder, Extension			Snowblower
Chaise Lounge			Lawn Mower, Hand			Spreader
Dog House/Cage			Lawn Mower, Power			Table, Patio
Garden Tools (5)			Lawn Mower, Riding			Table, Picnic
Glider/Settee			Leaf Sweeper			Table, Umbrella
Hose Caddy			Outdoor Gym			Wheelbarrow
Hibachi/Small BBQ			Outdoor Slide

Miscellaneous Items

Article	Quantity		Article	Quantity		Article	Quantity
Basket, Small			Hot Tub/Jacuzzi/Spa			Suitcase/Tote Box
Clothes Hamper/Basket			Ironing Board			Tool Chest, Small
Fan, Portable			Plant, Faux; Plant Stand			Tool Chest, Medium
Foot Locker			Power Tools (Group of 3)			Tool Chest, Large
Garbage Can, Outdoor			Shed, Tool or Utility			Toy, Plastic
Gun Cabinet/Locker			Shelf, Metal			Vacuum Cleaner
Heater, Gas or Electric			Sewing Machine, Portable			Work Bench

Cartons for Articles Packed By Owner

Article	Quantity		Article	Quantity
Dishpack			6.0/6.5 Cu Ft
Under 3.0 Cu Ft			Wardrobe
3.0 Cu Ft			Mirror/Glass Ctn
4.5 Cu Ft

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