| personal name * |
|
| family name * |
|
| E-Mail address* |
|
| Telephone number |
|
| Postal code |
|
| Postal code |
|
| Type of Service * |
|
| Planned Move Date |
|
| Building Layout |
|
| Moving Plan |
|
| Sofa |
|
| Bed |
|
| Desk |
|
| Bicycle |
|
| TV stand |
|
| Refrigerator |
|
| Washing machine |
|
| Air conditioner |
|
| Television |
|
| Other Items & Questions* |
|
