Self Survey Form

1Pick up

2Delivery

3Additional

4Goods

First name*
Last name*
Phone (incl. country code)*
E-mail*
Collection Address*
Postal code*
City*
Country*
Floor nr.
Inside elevator present?
Outside elevator required?
Pick up date
MM slash DD slash YYYY
Extra collection address (if applicable)
Do you require storage at origin?

First name*
Last name*
Phone (incl. country code)*
Email*
Delivery address*
Postal code*
City*
Country*
Floor nr.
Inside elevator present?
Outside elevator required?
Delivery date
MM slash DD slash YYYY
Extra delivery adress (if applicable)
Do you require storage at destination?

Are you paying privately or your employer?
Company name and contact
Do you want us to pack your boxes?
Do you have your own boxes?
Do you require us to dismantle any furniture?
Do you require us to reassemble your furniture?
Any heavy goods? (Like a piano, vault)
Any fragile goods? (Like antiques or instruments)
Any restrictions at collection address?
Any restrictions at delivery address?

Livingroom
- 3 pers. couch
  Please enter a number greater than or equal to 0.
- 3 pers. couch - m3
- 2 pers. couch
  Please enter a number greater than or equal to 0.
- 2 pers. couch - m3
- Fauteuil
  Please enter a number greater than or equal to 0.
- Fauteuil - m3
- Wall cabinet per part
  Please enter a number greater than or equal to 0.
- Wall cabinet - m3
- Chest of drawers
  Please enter a number greater than or equal to 0.
- Chest of drawers - m3
- TV-cabinet
  Please enter a number greater than or equal to 0.
- TV-cabinet - m3
- TV/Flat screen
  Please enter a number greater than or equal to 0.
- TV/Flat screen - m3
- Antique desk
  Please enter a number greater than or equal to 0.
- Antique desk - m3
- Desk
  Please enter a number greater than or equal to 0.
- Desk - m3
- Stereo equipment
  Please enter a number greater than or equal to 0.
- Stereo equipment - m3
- Standing clock
  Please enter a number greater than or equal to 0.
- Standing clock - m3
- Side table
  Please enter a number greater than or equal to 0.
- Side table - m3
- Coffee table(s)
  Please enter a number greater than or equal to 0.
- Coffee table(s) - m3
- Hocker
  Please enter a number greater than or equal to 0.
- Hocker - m3
- Carpet
  Please enter a number greater than or equal to 0.
- Carpet - m3
- Plants
  Please enter a number greater than or equal to 0.
- Plants - m3
- Pictures
  Please enter a number greater than or equal to 0.
- Pictures - m3
- Floor covering
  Please enter a number greater than or equal to 0.
- Floor covering - m3
- Moving boxes
  Please enter a number greater than or equal to 0.
- Moving boxes - m3
- Total
- Livingroom Total - m3
Bedroom 1
- 1-pers. bed
  Please enter a number greater than or equal to 0.
- 1-pers. bed - m3
- 2-pers. bed
  Please enter a number greater than or equal to 0.
- 1-pers. bed - m3
- Waterbed
  Please enter a number greater than or equal to 0.
- Waterbed - m3
- Surrounds of bed
  Please enter a number greater than or equal to 0.
- Surrounds of bed - m3
- Chest of drawers
  Please enter a number greater than or equal to 0.
- Chest of drawers - m3
- Bed cabinet/chair
  Please enter a number greater than or equal to 0.
- Bed cabinet/chair - m3
- Linen closet 2-drs
  Please enter a number greater than or equal to 0.
- Linen closet 2-drs - m3
- Linen closet 3-drs
  Please enter a number greater than or equal to 0.
- Linen closet 3-drs - m3
- Dressing table
  Please enter a number greater than or equal to 0.
- Dressing table - m3
- Wardrobe box
  Please enter a number greater than or equal to 0.
- Wardrobe box - m3
- Moving boxes
  Please enter a number greater than or equal to 0.
- Moving boxes - m3
- Total
- Bedroom 1 Total - m3
Bedroom 2
- 1-pers. bed
  Please enter a number greater than or equal to 0.
- 1-pers. bed - m3
- 2-pers. bed
  Please enter a number greater than or equal to 0.
- 2-pers. bed - m3
- Waterbed
  Please enter a number greater than or equal to 0.
- Waterbed - m3
- Surrounds of bed
  Please enter a number greater than or equal to 0.
- Surrounds of bed - m3
- Chest of drawers
  Please enter a number greater than or equal to 0.
- Chest of drawers - m3
- Bed cabinet/chair
  Please enter a number greater than or equal to 0.
- Bed cabinet/chair - m3
- Linen closet 2-drs
  Please enter a number greater than or equal to 0.
- Linen closet 2-drs - m3
- Linen closet 3-drs
  Please enter a number greater than or equal to 0.
- Linen closet 3-drs - m3
- Dressing table
  Please enter a number greater than or equal to 0.
- Dressing table - m3
- Wardrobe box
  Please enter a number greater than or equal to 0.
- Wardrobe box - m3
- Moving boxes
  Please enter a number greater than or equal to 0.
- Moving boxes - m3
- Total
- Bedroom 2 Total - m3
Diningroom
- Dining table
  Please enter a number greater than or equal to 0.
- Dining table - m3
- Chairs
  Please enter a number greater than or equal to 0.
- Chairs - m3
- Small furniture
  Please enter a number greater than or equal to 0.
- Small furniture - m3
- Closet
  Please enter a number greater than or equal to 0.
- Closet - m3
- Total
- Diningroom Total - m3
Bedroom 3
- 1-pers. /child’s bed
  Please enter a number greater than or equal to 0.
- 1-pers. /child’s bed - m3
- Bed board
  Please enter a number greater than or equal to 0.
- Bed board - m3
- Desk
  Please enter a number greater than or equal to 0.
- Desk - m3
- Bed cabinet/chair
  Please enter a number greater than or equal to 0.
- Bed cabinet/chair - m3
- Linen closet 2-drs
  Please enter a number greater than or equal to 0.
- Linen closet 2-drs - m3
- Wardrobe box
  Please enter a number greater than or equal to 0.
- Wardrobe box - m3
- Moving boxes
  Please enter a number greater than or equal to 0.
- Moving boxes - m3
- Total
- Bedroom 3 Total - m3
Kitchen
- Stove
  Please enter a number greater than or equal to 0.
- Stove - m3
- Dishwasher
  Please enter a number greater than or equal to 0.
- Dishwasher - m3
- Fridge
  Please enter a number greater than or equal to 0.
- Fridge - m3
- Closet
  Please enter a number greater than or equal to 0.
- Closet - m3
- Deepfreeze
  Please enter a number greater than or equal to 0.
- Deepfreeze - m3
- Dinette
  Please enter a number greater than or equal to 0.
- Dinette - m3
- Moving boxes
  Please enter a number greater than or equal to 0.
- Moving boxes - m3
- Total
- Kitchen Total - m3
Bedroom 4
- 1-pers. bed
  Please enter a number greater than or equal to 0.
- 1-pers. bed - m3
- 2-pers. bed
  Please enter a number greater than or equal to 0.
- 2-pers. bed - m3
- Surrounds of bed
  Please enter a number greater than or equal to 0.
- Surrounds of bed - m3
- Linen closet 2-drs
  Please enter a number greater than or equal to 0.
- Linen closet 2-drs - m3
- Chest of drawers
  Please enter a number greater than or equal to 0.
- Chest of drawers - m3
- Desk
  Please enter a number greater than or equal to 0.
- Desk - m3
- Shelves
  Please enter a number greater than or equal to 0.
- Shelves - m3
- Moving boxes
  Please enter a number greater than or equal to 0.
- Moving boxes - m3
- Total
- Bedroom 4 Total - m3
Study
- Desk
  Please enter a number greater than or equal to 0.
- Desk - m3
- Bookcase
  Please enter a number greater than or equal to 0.
- Bookcase - m3
- Chairs
  Please enter a number greater than or equal to 0.
- Chairs - m3
- Shelves
  Please enter a number greater than or equal to 0.
- Shelves - m3
- Moving boxes
  Please enter a number greater than or equal to 0.
- Moving boxes - m3
- Total
- Study Total - m3
Attic
- Cabinet
  Please enter a number greater than or equal to 0.
- Cabinet - m3
- Table
  Please enter a number greater than or equal to 0.
- Table - m3
- Camp equipment
  Please enter a number greater than or equal to 0.
- Camp equipment - m3
- Moving boxes
  Please enter a number greater than or equal to 0.
- Moving boxes - m3
- Total
- Attic Total - m3
Bathroom
- Washing machine
  Please enter a number greater than or equal to 0.
- Washing machine - m3
- Drier
  Please enter a number greater than or equal to 0.
- Drier - m3
- Closet
  Please enter a number greater than or equal to 0.
- Closet - m3
- Moving boxes
  Please enter a number greater than or equal to 0.
- Moving boxes - m3
- Total
- Bathroom Total - m3
Other
- Vacuum cleaner
  Please enter a number greater than or equal to 0.
- Vacuum cleaner - m3
- Ironing board
  Please enter a number greater than or equal to 0.
- Ironing board - m3
- Total
- Other Total - m3
Vehicles
- Motorbike
  Please enter a number greater than or equal to 0.
- Motorbike - m3
- Car
  Please enter a number greater than or equal to 0.
- Car - m3
- Total
- Vehicles Total - m3
Sports equipment
- Surfboard
  Please enter a number greater than or equal to 0.
- Surfboard - m3
- Diving gear
  Please enter a number greater than or equal to 0.
- Diving gear - m3
- Total
- Sports equipment Total - m3
Shed, Garage, Garden
- Work bench
  Please enter a number greater than or equal to 0.
- Work bench - m3
- Closet(s)
  Please enter a number greater than or equal to 0.
- Closet(s) - m3
- Tools
  Please enter a number greater than or equal to 0.
- Tools - m3
- Children bicycle(s)
  Please enter a number greater than or equal to 0.
- Children bicycle(s)- m3
- Adults bicycle(s)
  Please enter a number greater than or equal to 0.
- Adults bicycle(s)- m3
- Garden set
  Please enter a number greater than or equal to 0.
- Garden set - m3
- Garden chairs
  Please enter a number greater than or equal to 0.
- Garden chairs - m3
- Garden furniture
  Please enter a number greater than or equal to 0.
- Garden furniture - m3
- Garden furnish
  Please enter a number greater than or equal to 0.
- Garden furnish - m3
- Barbeque
  Please enter a number greater than or equal to 0.
- Barbeque - m3
- Shelves
  Please enter a number greater than or equal to 0.
- Shelves - m3
- Wood
  Please enter a number greater than or equal to 0.
- Wood - m3
- Wheelbarrow
  Please enter a number greater than or equal to 0.
- Wheelbarrow - m3
- Step ladder
  Please enter a number greater than or equal to 0.
- Step ladder - m3
- Pots
  Please enter a number greater than or equal to 0.
- Pots - m3
- Plants
  Please enter a number greater than or equal to 0.
- Plants - m3
- Moving boxes
  Please enter a number greater than or equal to 0.
- Moving boxes - m3
- Total
- Shed, Garage, Garden Total - m3
Total
- Total volume
Phone
This field is for validation purposes and should be left unchanged.