Leisure Coast Removals Pty Ltd

May we suggest that you first print out the form, enter the details while you are
off - line, giving as much detail as possible
and then re-entering the information while you are online.
This will ensure that we can supply a more precise quotation on your move.

You can also fax the filled in form to us if you prefer.
Should the print button not work on your browser, use your normal method of printing out this page.

Where you see this symbol please use the comments section at the bottom of the form to give us a better idea of the measurement of the item.

1.YOUR DETAILS PLEASE:
Do not forget to include your fax number, should you require the quotation faxed to you

NAME:
PHONE No:
FAX No:	Please Fax me quotation
EMAIL:

UPLIFT ADDRESS: Post Code:		DELIVERY ADDRESS: Post Code:
Pre-Pack Date:
Uplift Date:		Deliver Date:
Uplift Access:		Del. Access:
3. If either address is outside of Town Area, please give details (if possible) of:
Distance from Town		Type of Road Surface
4. PACKING REQUIREMENTS:
Do you require packing?		Do you require unpacking?
If packing/unpacking is required please indicate below the items you require packed/unpacked

LINEN:	PACK UNPACK	KITCHEN UTENSILS:	PACK UNPACK
CLOTHING:	PACK UNPACK	PICTURES:	PACK UNPACK
GLASSWARE:	PACK UNPACK	TOOLS:	PACK UNPACK
CROCKERY:	PACK UNPACK	TOYS:	PACK UNPACK

Note: We will allow for two Port-a-Robes to transport your hanging clothes.
This is equivalent to approximately 1.0m of hanging space.
If you require more Port-a-Robes, please indicate number required:
If packing yourself, please complete the following:
Approximate number of cartons: Approximate size of cartons used/to be used:

5. Do you have any pot plants to be moved? YES/NO
(Plants must be dry, clean and spider free and boxed where possible)

If YES, please indicate approximate size and number of Plants:
Large: Medium: Small:
Other - please specify:

6. Do you have any large or bulky items that will need to be dismantled? (ie swings, play frames, shade houses etc.)
YES/NO

If YES, please indicate type etc.

7. INSURANCE: REQUIRED Indicate Preferred Cover:
Declared Value: (additional information may be required)
8. Who is paying the account?
(If company, an official order or Letter of Authority is required)

PLEASE COMPLETE THE FOLLOWING GIVING AS MUCH DETAIL AS POSSIBLE TO ENABLE US TO SUBMIT A MORE ACCURATE QUOTATION. Thank You.

BEDROOM 1	No	BED4/STUDY	No	DINING ROOM	No	FAMILYROOM	No
Wardrobe		Wardrobe		Table		Lounge 2 Seat
Dress.Table		Single Ens		Dining Chairs		Lounge 1 Seat
Queen.Ens		Bed Head		Traymobile		Lounge Module
Bed Head		Dress.Table		Buffet		Bookcase
Bedside Table		Tallboy		Buffet Hutch		Buffet Hutch
Tallboy		Chest of drawers		Crystal Cabinet		Coffee Table
Chest of Drawers		Student Desk		Bookcase		Television
Blanket Box		Bookcase		Std Carton		TV Stand
Cheval Mirror		Bookshelf		Book Carton		Ent Unit 1.5m
Arm Chair		Chair		Pic Pack		Std Cartons
Television		Office Desk				Book Cartons
Std Carton		File Cab 2/3/4				Pic Pack
Book Carton		Comp. Desk
Porta Robes		Sofa Bed		LOUNGEROOM	No
		Sewing Cab.		Lounge 3 Seat		OUTSIDE	No
BEDROOM 2	No	Std Carton		Lounge 2 Seat		Outdoor Table
Wardrobe		Book Carton		Lounge 1 Seat		Outdoor Chairs
Single Ens		Porta Robes		Chairs Other		Webber BBQ
Bedhead		Bedside Table		Lounge Module		Std BBQ
Dressing Table				Coffee Table		Golf Clubs
Tallboy				Lamp Std.		Golf Buggy
Chest of Drawers		NURSERY	No	Occ Table		Dog Kennel
Student Desk		Cot		Television		Suitcases
Bookcase		Bassinette		Video		Folding Bed
Bookshelf		Lowboy		Stereo		Cupboard 1.0
Chair		Change Table		Wall Unit 1.0m		Shelf Unit 1.0
Std Carton		Rocking Chair		Bookcase		Std Cartons
Book Carton		Pram		Ent Unit 1.5m		Book Cartons
Porta Robes		Stroller		TV Stand		Toolboxes
		Std Carton		China Cabinet		Surf Board
BEDROOM 3	No	Book Carton		Heater		Childs Toys
Wardrobe				Piano/Organ		Bicycle
Single Ens				Piano Stool		Bike Rack
Bedhead				Mag Tidy		Bins
Dressing Table		KITCHEN	No	Nest Table		Car Ramp
Tallboy		Table		Std Carton		Esky
Chest of drawers		Dining Chairs		Book Carton		Fold Chair
Student Desk		Refrigerator		Pic Pack		Fold Lounge
Bookcase		Freezer Up/r				Garden Seat
Bookshelf		Freezer Chest				Garden tools
Chair		Buffet Hutch				Ladder
Std Carton		Microwave		LAUNDRY	No	Mower
Book Carton		Micro. Stand		Wash Machine		Whipper Snip.
Porta Robes		Stools		Dryer		Wheelbarrow
BedSide Table		Kitchen Tidy		Cupboard 1.0		Trunks
HALL	No	Dishwasher		Iron Board		Skis
G.Clock		High Chair		Airer		Swing
Drop S/Table		Std Carton		Baskets		Work Bench
Hall Stand		Book Carton		Brooms etc.		Trampoline
Hall Table		Sub-Total		Freezer		Carton Total
Hat Stand				Std Carton		Std Cartons
Pedestal				Book Carton		Book Cartons
Phone Table						Porta Robes
Pic Pack						Pic Pack
Sub-Total						Sub-Total

COMMENTS:
Please Supply additional information and list pieces you may have, that are not listed above.

COMMENTS:
Please Supply approx. measurements of pieces above marked with a

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