Title:
Surname:
First Name:
House No.:
Street Name:
Postcode:
Tel 1:
Tel 2:
Email:
Date of move or approx time of year for moving (if known)
Are you completing on this day yes/no or renting only?	Yes No Renting
Delivery address and postcode:
Number of bedrooms (collection address):
Floor level at collection:
Lift at collection:	Yes No
Floor level at delivery:
Lift at delivey:	Yes No
• Please list all your furniture including garden furniture,plants,shed contents, loft and cellar items to be moved:
Do you require us to provide a price for packing contents?	Yes No
Do you require packaging?	Yes No
Do you require us to unpack at your delivery address?(Unpacking will usually take place the day after your move)	Yes No
Approx number of walking paces (excluding stairs but including corridors if apartment, drive ways footpaths etc.) to parking position at collection?
Approx number of walking paces (excluding stairs but including corridors if apartment, drive ways footpaths etc.) to parking position at delivery?
Do you require Total Removals to extend our contractual liability for your household effects (£30,000)? Please note your household insurance may cover the move and you may qualify for a discount if you arrange your own insurance.*	Yes No
How did you find us?	Yell.com Yahoo Estate Agent Recommendation Up My Street Thomson Local Google Leaflet

Do you require a quotation for pre/post tenancy domestic clean or carpet clean? Our partners, SPARKLE & SHINE can be contacted on 07802 574819

*Please note that where extended liability has not been purchased nor is included in the quotation, liability is strictly limited to £40.00 per article.

Copyright London Total Removals 2006