.: OMEGA VAN LINES :.

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Estimate Form


Contact Information
Full Name:*
E-Mail Address:*
Home Phone:*
Work Phone:	Extension:
Fax:

Estimated move date:

Moving from

Moving to

Address:
City:
State:
Zip Code:
Home Size:
Elevator:	Yes No
If walk up, write # of Floors:

Address:
City:
State:
Zip Code:
Home Size:
Elevator:	Yes No
If walk up, write # of Floors:

Will you need: Packing Unpacking Storage

Item	Qty
Air Conditioner
Armoire
Bed - Bunk
Bed Frame
Bed - Single
Bed - Full/Double
Bed - Queen/King
Bicycle
Book Case
Book Shelf
Buffet Base
Buffet top
Cabinet - Curio
Cabinet - Display
Cabinet - Large
Chair-Child/folding
Chair-Dining
Chair-Living Room
Chair-Office
Chair-overstuffed
Chair-Rocking/arm

Item	Qty
Chest / Trunk
Computer
Desk - Large
Desk - Small
Dresser - Small
Dresser-Medium
Dresser-Large
Ent. Center-small
Ent. Center-med.
Ent. Center-Large
File Cabinet - 2
File Cabinet - 4
Futon
Futon Frame
Ironing Board
Ladder
Lamp
Microwave
Mirror - Picture
Piano - Grand
Piano - Upright

Item	Qty
Rack / Bakers
Refrigerator - Med.
Refrigerator - Large
Rug
Sofa-Regular
Sofa-Large
Sofa- Loveseat
Stereo
Table - Coffee / Sofa
Table - Dining
Table - End / Night
Table - Kitchen
toolbox
TV stand
TV - Small 20"
TV - Medium 29"
TV - Large 36"
TV - Big Screen
Vacuum Cleaner
VCR - Component
Washer/Dryer

Additional Items	Qty

Order Boxes	Qty
Book Box- Small
Linen Box-Medium
China Box-Large
Picture Box
Wardrobe
White Paper

Additional Comments

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