First Name


Last Name


Phone Number


E-mail Address




1. Where are you moving to and from, include the town & state?
   
   
   
2. Are there any Elevators and/or Flights of Stairs at either location?
   Yes No
   
   
3. Can a 53-foot truck park within 75 feet of your front door?
   Yes No
   
   
4. Let us know about any large items such as, pianos, hot tubs, etc.
   
   
   
5. When do you want to move?
   
   
   
6. Would you like us to pack?
   Yes No
   
   
7. How many rooms of furniture are you moving?
   For a more accurate estimate, provide us with a detailed list of items -
   don't forget to include the number of boxes.
   
   
   
8. Many companies have transportation agreements with Stevens Worldwide Van Lines,
   let us know who will be paying for your relocation.
   
   
   
9. Need a car quote?
   Yes No
   
   Include the year, make and model.
   
   
   
10. Would you like a Realtor to contact you?
    Yes No
    
    

FYI - Payment Terms:

1. Upon Delivery: Cash, Certified Check, Money Order, or Travelers Checks
2. Major Credit Cards are accepted. A simple authorization form must be completed prior to loading. The corporate office manages this process, not the driver.
3. If your company is paying for the move, tell us. We will assist you with the necessary paperwork to set up a direct billing.