Please complete part 1 and 2
Part 1
PERSONAL / REMOVAL DETAILS
'Please fill fields marked
*
Name
*
:
Home Tel
*
:
Work/Mobile:
Email:
Removal Month:
January
February
March
April
May
June
July
August
September
October
November
December
Value of Insurance
Cover required:
Packing Materials:
I require a packing service.
I wish to have packing materials supplied.
I am supplying my own boxes.
PROPERTY DETAILS
Removals
House No/Name:
Street
*
:
Town
*
:
Country
*
:
Postcode:
House Type:
House
Purpose Built Flat
Maisonette
Bedrooms:
1
2
3
4
5 or more
Receptions:
1
2
3 or more
Collection/Delivery Floor:
Ground
1
st
2
nd
3
rd
or above
Is there a lift:
Yes
No
Parking:
Outside Property
Yellow Line(s)
Red Route
Car Park
Parking distance from door?:
Removal Access through windows:
Yes
No
Removals To
House No/Name:
Street
*
:
Town
*
:
Country
*
:
Postcode:
If not known,
estimated miles:
0 - 20 miles
21 – 60 miles
House Type:
House
Purpose Built Flat
Maisonette
Bedrooms:
1
2
3
4
5 or more
Receptions:
1
2
3 or more
Collection/Delivery Floor:
Ground
1
st
2
nd
3
rd
or above
Is there a lift:
Yes
No
Parking:
Outside Property
Yellow Line(s)
Red Route
Car Park
Parking distance from door?:
Removal Access through windows:
Yes
No
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