To arrange for a free estimate on moving your household goods WITHIN the U.S., please complete and submit the following form or contact us at 1-888-336-1336.

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


Name:
Home phone:
Work phone:
Email:
Address Moving From (include apartment number):
City:
State: Zip:


Address Moving To (include apartment number):
City:
State: Zip:



Approximate moving date:
Please check if storage is required
For approximately how long?

Would you like GoldStar Van Lines to pack All? 
Would you like GoldStar Van Lines  to pack only fragile items? 
Would you like GoldStar Van Lines  to unpack All? 
Would you like GoldStar Van Lines  to unpack fragile items only? 

Comments:

Please complete this form:


Living Room
article # pieces article # pieces article # pieces
Bar Footstool Sofa, Loveseat
Bench, Frsd/Piano Hall Tree Rack Sofa, 3 Cushion
Bookcase Hall Tree Large Sofa, Hide, 4 Cush
Bookshelves, Sect. Lamp, Floor Stereo Component
Cabinet, Curio Lamp, Pole Stereo, Console
Chair, Straight Magazine Rack Tables, Dropl/Occas
Chair, Arm Music Cabinet Tables, Coffee
Chair, Rocker Piano Baby Gr/Upr Tables, End
Chair, Occasional Piano, Grand Telephone Stand
Chair, Overstuffed Piano, Spinet/Console TV, Portable
Chest Radio, Table TV, Table Model
Clock, Grandfather Rec. Player, Port. TV, Console
Day Bed Rugs Lg Roll/Pad TV, Combination
Desk, SM/Winthrop Rugs Sm Roll/Pad TV Stand
Desk, Secretary Sofa Rattan/Wicker Trunk
Fireplace Equip. Sofa, Sec., Per Sec.

Dining Room
article # pieces article # pieces article # pieces
Bench, Harvest Dining Table Tea Cart
Buffet (Base) Dining Chair Rugs, Large or Pad
Hutch (Top) Server Rugs, Small or Pad
Cabinet, Corner

Bedroom
article # pieces article # pieces article # pieces
Bed Incl Sp/Matt Chair, Boudoir Dresser Single
Bed, Waterbed Base Chair, Str/Rocker Dresser Double
Bed, Rollaway Chaise Lounge Dresser, Triple
Bed, Single/Hollywood Chest, Bachelor Night Table
Bed, Std/Double Chest, Cedar Rug, Large or Pad
Bed, Queen Chest, Armoire Rug, Small or Pad
Bed, King Desk, SM/Winthrop Wardrobe, Small
Bed, Bunk (Set 2) Dresser/Vanity Sch Wardrobe, Large
Bookshelves, Sect. Dresser, Vanity

Nursery
article # pieces article # pieces article # pieces
Bathinette Chest Playpen
Bed, Youth Chest, Toy Rug, Large or Pad
Chair, Child's Crib, Baby Rug, Small or Pad
Chair, High Table, Child's

Appliances
article # pieces article # pieces article # pieces
Air Cond/Wind Sm Freezer, 16 or Over Refrigerator, 7 to 10 cu ft
Air Cond/Wind Lg Range, 20" Wide Refrigerator, 11 cu ft/over
Dehumidifier Range, 30" Wide Trash Compactor
Dishwasher Range, 36" Wide Vacuum Cleaner
Freezer   Refrigerator (CuCp)   Washing Machine
Freezer, 10 or less Refrigerator, 6 cu ft or less Dryer
Freezer, 11 to 15

Kitchen
article # pieces article # pieces article # pieces
Bkft Suite, Chairs Kitchen Cabinet Stool
Breakfast Table Microwave Oven Table
Chair, High Serving Cart Utility Cabinet
Ironing Board

Porch and Outdoor
article # pieces article # pieces article # pieces
BBQ Grill, Small Lawn Mower, Hand Roller, Lawn
BBQ Grill, Large Lawn Mower, Power Rug, Large
Chairs, Aluminum Lawn Mower, Riding (HP) Rug, Small
Chairs, Metal Leaf Sweeper Sandbox
Chairs, Wood Outdoor Child Slide Spreader
Gard. Hose & Tools Outdoor Child Gym Table, Small
Glider or Sattee Outdoor Dry. Racks Table, Large
Ladder, 6' Step Outdoor Swings Umbrella
Ladder, 8' Metal Picnic Table Wheelbarrow
Ladder, Extension Picnic Bench

Miscellaneous
article # pieces article # pieces article # pieces
Baby Carriage Filing Cab. 2 door Sewing Machine w/Cabinet
Barbells Filing Cab. 4 door Sled
Basket (Clothes) Footlockers Suitcase
Bicycle Game Table Table, Utility
Tricycle Golf Bag Tackle Box
Bowling Ball/Bag Heater, Gas/Elec Tire
Card Table Metal Shelves Tire w/Rim
Folding Chairs Ping Pong Table Toolchest, Small
Clothes Hamper Pool Table, Comp. Toolchest, Medium
Cot, Folding Pool Table, Slate Toolchest, Large
Desk, Office Power Tool, Hand Ea. Trash Can
Fan Power Tool Stand Wagon, Child's
Fern/Plant Stands Sewing Machine, Port. Wastepaper Basket
Filing Cab. Crdbd Sewing Machine, Console Work Bench

Cartons
article # pieces article # pieces article # pieces
Dish-pack Book Box Medium Box
TV box Linen Box China Box
Questions or Comments:
--------Please Submit the Form and our Representative
--------will contact you with the Estimate.



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