Date *

MM

DD

YYYY

Time *

Hour

Minute

Second

AM PM

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

ITEMS *

1 loveseat or armchair

5–10 moving boxes

Small dresser or nightstand

Bagged clutter, lamps, decor, etc.

Light garage or closet cleanout