• MC# 419849 • USDOT# 1164414

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Please complete the questions below, and click "Submit My Information." You should receive a response from a customer service representative within 48 hours!

You may also call Delta Van Lines at 800-544-1380 for a free quote over the phone.

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Personal Information

* First Name:

* Last Name:

* Home Phone:

Work Phone:

* E-Mail Address:

Best Time to be Contacted:

Preferred Response:

* Approximate Moving Date:

Moving From

* Address:
* State:
* City:
* Zip Code:
# of Flights of Stairs:
Elevator: Yes No

Moving To

Address:
* State:
* City:
* Zip Code:
# of Flights of Stairs:
Elevator: Yes No

Living Room

Item	CF	Quantity
Bar, Portable	15
Bench, Fireside or Piano	5
Bookcase	20
Bookshelves, sectional	5
Chair, Arm	10
Chair, Occasional	15
Chair, Overstuffed	25
Chair, Rocker	12
Chair, Straight	5
Clock, Grandfather	20
Day Bed	30
Desk, Small or Winthrop	22
Desk, Secretary	35
Computer	5

Item	CF	Quantity
Fireplace Equipment	5
Foot Stool	2
Lamp, Floor or Pole	3
Magazine Rack	2
Music Cabinet	10
Piano, Baby Gr. or Upr.	70
Piano, Parlor Grand	80
Piano, Spinet	60
Radio, Table	2
Record Player Port.	2
Rugs, Large Roll or Pad	10
Rugs, Small Roll or Pad	3
Plasma TV	10

Item	CF	Quantity
Sofa, 2 Cushions	35
Sofa, 3 Cushions	50
Sofa, 4 Cushions	60
Sofa, Sectional, per sect.	30
Stereo	20
Stud, Couch and Hideabed	50
Tables, Dropl'f Occas.	12
Tables, Coffee, End or Nest	5
Telephone Stand and Chair	5
Television Combination	25
Television or Radio Console	15
Television Table Model	10

Dining Room

Item	CF	Quantity
Bench, Harvest	10
Buffet	30
Cabinet, Corner	20
Cabinet, China	25

Item	CF	Quantity
Chair, Dining	5
Server	15
Table Dining	30

Item	CF	Quantity
Tea Cart	10
Rugs, Large Roll or Pad	10
Rugs, Small Roll or Pad	3

Bedrooms

Item	CF	Quantity
Bed, Incl. Spring and Mattr.	Please select below
Bed, Queen	65
Bed, King Size	70
Bed, Single or Hollywood	40
Bed, Rollaway	20
Bed, Bunk (set of 2)	70
Bookshelves	5

Item	CF	Quantity
Bureau, Dresser, Chest of Drawers	25
Cedar Chest	15
Chair, Boudoir	10
Chair, Straight or Rocker	5
Chaise Lounge	25
Desk, Small or Winthrop	22
Dresser of Vanity Bench	3

Item	CF	Quantity
Dresser, Double (Mr. & Mrs.)	50
Night Table	5
Rugs, Large Roll or Pad	10
Rugs, Small Roll or Pad	3
Vanity Dresser	20
Wardrobe, Small	20
Wardrobe, Large	40

Nursery

Item	CF	Quantity
Bassinette	5
Bed, Youth	30
Chair, Childs	3
Chair, High	5

Item	CF	Quantity
Chest	12
Chest, Toy	5
Crib, Baby	10
Table, Child	5

Item	CF	Quantity
Pen, Play	10
Rugs, Large Roll or Pad	10
Rugs, Small Roll or Pad	3

Kitchen

Item	CF	Quantity
Breakfast, Suite Chairs	5
Breakfast Table	10
Chair, High	5
Ironing Board	2

Item	CF	Quantity
Kitchen Cabinet	30
Roaster	5
Serving cart	15
Stool	3

Item	CF	Quantity
Pen, Play	5
Rugs, Large Roll or Pad	10
Rugs, Small Roll or Pad	3

Appliances

Item	CF	Quantity
Air Conditioner	30
Dehumidifier	10
Dishwasher	20
Dryer, Electric or Gas	25
Ironer or Mangle	12
Range, Electric or Gas	30

Item	CF	Quantity
Refrigerator	Please select below
6 Cubic Feet or less	30
7 to 10 Cubic Feet	45
11 Cubic Feet or More	60
Vacuum Cleaner	5
Washing Machine	25

Item	CF	Quantity
Freezer, Cu. Capacity	Please select below
10 Cubic Feet or less	30
11 to 15 Cubic Feet	45
16 Cubic Feet and Up	60

Porch, Outdoor Furniture & Equipment

Item	CF	Quantity
Barbecue or Port. Grill	10
Bath, Bird	5
Chairs, Lawn	5
Chairs, Porch	10
Clothes, Line	5
Clothes, Dryer Rack	5
Garden Hose and Tools	10
Glider or Settee	20
Ladder, Extension	10
Lawn Mower, Hand	5

Item	CF	Quantity
Lawn Mower, Power	15
Lawn Mower, Riding	35
Leaf Sweeper	5
Outdoor Childs Slide	10
Outdoor Childs Gym	20
Outdoor Drying Racks	5
Outdoor Swings	30
Picnic Table	20
Picnic Bench	5
Porch Chair	10

Item	CF	Quantity
Rocker, Swing	15
Roller, Lawn	15
Rug, Large	7
Rug, Small	3
Sand Box	10
Settee	20
Spreader	1
Table	10
Umbrella	5
Wheel Barrow	8

Miscellaneous

Item	CF	Quantity
Ash or Trash Can	7
Basket (Clothes)	5
Bicycle	10
Bird Cage and Stand	5
Card Table	1
Cabinet, Filing	20
Carriage, Baby	20
Chairs, Folding	1
Clothes, Hamper	5
Cot, Folding	10
Desk, Office	30

Item	CF	Quantity
Fan	5
Fernery or Plant Stands	10
Foot Lockers	5
Garbage Cans	7
Golf Bag	2
Heater, Gas or Electric	5
Incinerator	10
Metal Shelves	5
Ping Pong Table	20
Pool Table	40
Power Tools	20

Item	CF	Quantity
Sewing Machine	15
Sled	15
Step Ladder	7
Suitcase	3
Table, Utility	10
Tackle Box	20
Tool Chest	1
Tricycle	10
Wagon, Child's	5
Waste Paper Basket	8
Work Bench	8

Boxes

Item	CF	Quantity
Small	1.5
Medium	3

Item	CF	Quantity
Large	6
Wardrobe	15

Item	CF	Quantity
Picture	5
Dishpak	10

Additional Information

Would you like your car shipped? (Please note year, make, & model):

Would you need your household goods in storage?

Yes No

Would you like a full packing service?

Yes No

Your sales representative's name (if known):

Some questions you may have:

* Total Cubic Feet =

* Total Weight =

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(Minimum Shipment 2,000 LBS.)

Note: The information collected from this form is for internal use only. Your information will not be sold or distributed to anyone.

211 NW 5th Ave. Hallandale FL, 33009

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