Step 1 of 2
*Contact Name
*Address
*Contact No
Email Address
Removal Date
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2012 2013 2014
Value of Insurance Cover required
Removal From / To
Removals From
Property Type
House Bungalow Flat Business
Floor Type
ground 1st 2nd 3rd 4th 5th higher
Bed Rooms
Receptions
Access Type
lift small lift large lift
Carry Type
long short
Parking
Yellow line Meters suspended Residential parking
Distance From door?
Access through windows
Yes No
Removals To
Removal Properties and Packing
Living room/ dining room
Sub Total (£):
Kitchen
Bedroom
General
Outside effects
Not Listed above
Not Listed Packing above
Grand Total (£):
Dismantle / Erection
Wardrobes
Beds
Kitchen Units
Grandfather Clocks
Pianos
Others