Survey Cover SheetSurvey Information"*" indicates required fieldsStep 1 of 250%Basic InformationCustomer Name*Surveyor OfficeLa CrosseMankatoMinneapolis – St. PaulRochesterOA Survey?NoYesPiepho National Account?*NoAshley FurnitureCartusFederated InsuranceGMSHormelMenardsSIRVA Move ManagementUniversity of WisconsinMove Consultant Email* Origin LogisticsType of Home*Single Family HouseApartmentTownhomeMini StorageOtherComplex NameOther TypeOrigin Closing/Possession Details (Dates, times, etc.)*Destination Closing/Possession Details (Dates, times, etc.)*Stairs*None1 Flight2 Flights3 Flights4+ FlightsElevator*NoYesElevator Reservation RequiredNoYesLong Carry*None50-100 Feet100-150 Feet150-200 Feet200+ FeetShuttle Required*NoYesSteep Driveway*NoYesItems in Attic*NoYesCustomer to Remove Items from AtticYesNoWeight Restrictions*NoYesParking Meter Permits*NoYesMeter NumbersCOI Required*NoYesGated Community*NoYesCul-de-sac*NoYesOther Logistics Notes?Bulky ItemsBulky Item 1NoneBig Screen TVRiding MowerTrailerHot TubGrand PianoBaby Grand PianoUpright PianoGun SafeBulky Item 2NoneBig Screen TVRiding MowerTrailerHot TubGrand PianoBaby Grand PianoUpright PianoGun SafeBulky Item 3NoneBig Screen TVRiding MowerTrailerHot TubGrand PianoBaby Grand PianoUpright PianoGun SafeBulky Item 4NoneBig Screen TVRiding MowerTrailerHot TubGrand PianoBaby Grand PianoUpright PianoGun SafeAdditional BulkiesGun SafesGun Safe 1 MakeGun Safe 1 ModelGun Safe 1 WeightGun Safe 2 MakeGun Safe 2 ModelGun Safe 2 WeightGun Safe 3 MakeGun Safe 3 ModelGun Safe 3 WeightAppliancesWasherFront LoadTop LoadNoneWasher Service?N/AMover to ServiceCustomer to ServiceReviewed Washer Must be Drained With Bolts InstalledYesNoWasher MakeAmanaBoschElectroluxFisher & PaykelFrigidaireGEKenmoreLGMaytagRoperSamsungWhirlpoolOtherWasher ModelDryerNoneGasElectricDryer ServiceMover to ServiceCustomer to ServiceIce MakerNoneYes – Mover to DisconnectYes – Customer to DisconnectAdditional Third Party ServicesGrandfather ClockNoneYes – Mover to ServiceYes – Mover to Service and CrateYes – Customer to ServiceSwing SetNoneYes – Mover to ServiceYes – Customer to ServiceSwing Set InformationPool TableNoneYesPool Table Service?NoYes – Mover to Service and Crate (1 Piece)Yes – Mover to Service and Crate (3 Piece)Flat Screen TVsSizeRemoval from Wall?NoYesSize 2Removal from Wall 2NoYesSize 3Removal from Wall 3NoYesSize 4Removal from Wall 4NoYesSize 5Removal from Wall 5NoYesSize 6Removal from Wall 6NoYesCrating ServicesCrating Item 1Item 1 RoomItem 1 DimsCrating Item 2Item 2 RoomItem 2 DimsCrating Item 3Item 3 RoomItem 3 DimsCrating Item 4Item 4 RoomItem 4 DimsCrating Item 5Item 5 RoomItem 5 DimsCrating Item 6Item 6 RoomItem 6 DimsOther TVs, Crating, Survey NotesUpload Survey Pictures Drop files here or Select filesMax. file size: 128 MB.Δ
