Self Survey Form Close 1Pick up2Delivery3Additional4GoodsFirst name*Last name*Phone (incl. country code)*E-mail* Collection Address*Postal code*City*Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsFloor nr.Inside elevator present?YesNoOutside elevator required?YesNoPick up date MM slash DD slash YYYY Extra collection address (if applicable)Do you require storage at origin?YesNoFirst name*Last name*Phone (incl. country code)*Email* Delivery address*Postal code*City*Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsFloor nr.Inside elevator present?YesNoOutside elevator required?YesNoDelivery date MM slash DD slash YYYY Extra delivery adress (if applicable)Do you require storage at destination?YesNoAre you paying privately or your employer?PrivatelyMy employerCompany name and contactDo you want us to pack your boxes?YesNoDo you have your own boxes?YesNoDo you require us to dismantle any furniture?YesNoDo you require us to reassemble your furniture?YesNoAny heavy goods? (Like a piano, vault)Any fragile goods? (Like antiques or instruments)Any restrictions at collection address?Any restrictions at delivery address?Livingroom3 pers. couchPlease enter a number greater than or equal to 0.3 pers. couch - m32 pers. couchPlease enter a number greater than or equal to 0.2 pers. couch - m3FauteuilPlease enter a number greater than or equal to 0.Fauteuil - m3Wall cabinet per partPlease enter a number greater than or equal to 0.Wall cabinet - m3Chest of drawersPlease enter a number greater than or equal to 0.Chest of drawers - m3TV-cabinetPlease enter a number greater than or equal to 0.TV-cabinet - m3TV/Flat screenPlease enter a number greater than or equal to 0.TV/Flat screen - m3Antique deskPlease enter a number greater than or equal to 0.Antique desk - m3DeskPlease enter a number greater than or equal to 0.Desk - m3Stereo equipmentPlease enter a number greater than or equal to 0.Stereo equipment - m3Standing clockPlease enter a number greater than or equal to 0.Standing clock - m3Side tablePlease enter a number greater than or equal to 0.Side table - m3Coffee table(s)Please enter a number greater than or equal to 0.Coffee table(s) - m3HockerPlease enter a number greater than or equal to 0.Hocker - m3CarpetPlease enter a number greater than or equal to 0.Carpet - m3PlantsPlease enter a number greater than or equal to 0.Plants - m3PicturesPlease enter a number greater than or equal to 0.Pictures - m3Floor coveringPlease enter a number greater than or equal to 0.Floor covering - m3Moving boxesPlease enter a number greater than or equal to 0.Moving boxes - m3TotalLivingroom Total - m3Bedroom 11-pers. bedPlease enter a number greater than or equal to 0.1-pers. bed - m32-pers. bedPlease enter a number greater than or equal to 0.1-pers. bed - m3WaterbedPlease enter a number greater than or equal to 0.Waterbed - m3Surrounds of bedPlease enter a number greater than or equal to 0.Surrounds of bed - m3Chest of drawersPlease enter a number greater than or equal to 0.Chest of drawers - m3Bed cabinet/chairPlease enter a number greater than or equal to 0.Bed cabinet/chair - m3Linen closet 2-drsPlease enter a number greater than or equal to 0.Linen closet 2-drs - m3Linen closet 3-drsPlease enter a number greater than or equal to 0.Linen closet 3-drs - m3Dressing tablePlease enter a number greater than or equal to 0.Dressing table - m3Wardrobe boxPlease enter a number greater than or equal to 0.Wardrobe box - m3Moving boxesPlease enter a number greater than or equal to 0.Moving boxes - m3TotalBedroom 1 Total - m3Bedroom 21-pers. bedPlease enter a number greater than or equal to 0.1-pers. bed - m32-pers. bedPlease enter a number greater than or equal to 0.2-pers. bed - m3WaterbedPlease enter a number greater than or equal to 0.Waterbed - m3Surrounds of bedPlease enter a number greater than or equal to 0.Surrounds of bed - m3Chest of drawersPlease enter a number greater than or equal to 0.Chest of drawers - m3Bed cabinet/chairPlease enter a number greater than or equal to 0.Bed cabinet/chair - m3Linen closet 2-drsPlease enter a number greater than or equal to 0.Linen closet 2-drs - m3Linen closet 3-drsPlease enter a number greater than or equal to 0.Linen closet 3-drs - m3Dressing tablePlease enter a number greater than or equal to 0.Dressing table - m3Wardrobe boxPlease enter a number greater than or equal to 0.Wardrobe box - m3Moving boxesPlease enter a number greater than or equal to 0.Moving boxes - m3TotalBedroom 2 Total - m3DiningroomDining tablePlease enter a number greater than or equal to 0.Dining table - m3ChairsPlease enter a number greater than or equal to 0.Chairs - m3Small furniturePlease enter a number greater than or equal to 0.Small furniture - m3ClosetPlease enter a number greater than or equal to 0.Closet - m3TotalDiningroom Total - m3Bedroom 31-pers. /child’s bedPlease enter a number greater than or equal to 0.1-pers. /child’s bed - m3Bed boardPlease enter a number greater than or equal to 0.Bed board - m3DeskPlease enter a number greater than or equal to 0.Desk - m3Bed cabinet/chairPlease enter a number greater than or equal to 0.Bed cabinet/chair - m3Linen closet 2-drsPlease enter a number greater than or equal to 0.Linen closet 2-drs - m3Wardrobe boxPlease enter a number greater than or equal to 0.Wardrobe box - m3Moving boxesPlease enter a number greater than or equal to 0.Moving boxes - m3TotalBedroom 3 Total - m3KitchenStovePlease enter a number greater than or equal to 0.Stove - m3DishwasherPlease enter a number greater than or equal to 0.Dishwasher - m3FridgePlease enter a number greater than or equal to 0.Fridge - m3ClosetPlease enter a number greater than or equal to 0.Closet - m3DeepfreezePlease enter a number greater than or equal to 0.Deepfreeze - m3DinettePlease enter a number greater than or equal to 0.Dinette - m3Moving boxesPlease enter a number greater than or equal to 0.Moving boxes - m3TotalKitchen Total - m3Bedroom 41-pers. bedPlease enter a number greater than or equal to 0.1-pers. bed - m32-pers. bedPlease enter a number greater than or equal to 0.2-pers. bed - m3Surrounds of bedPlease enter a number greater than or equal to 0.Surrounds of bed - m3Linen closet 2-drsPlease enter a number greater than or equal to 0.Linen closet 2-drs - m3Chest of drawersPlease enter a number greater than or equal to 0.Chest of drawers - m3DeskPlease enter a number greater than or equal to 0.Desk - m3ShelvesPlease enter a number greater than or equal to 0.Shelves - m3Moving boxesPlease enter a number greater than or equal to 0.Moving boxes - m3TotalBedroom 4 Total - m3StudyDeskPlease enter a number greater than or equal to 0.Desk - m3BookcasePlease enter a number greater than or equal to 0.Bookcase - m3ChairsPlease enter a number greater than or equal to 0.Chairs - m3ShelvesPlease enter a number greater than or equal to 0.Shelves - m3Moving boxesPlease enter a number greater than or equal to 0.Moving boxes - m3TotalStudy Total - m3AtticCabinetPlease enter a number greater than or equal to 0.Cabinet - m3TablePlease enter a number greater than or equal to 0.Table - m3Camp equipmentPlease enter a number greater than or equal to 0.Camp equipment - m3Moving boxesPlease enter a number greater than or equal to 0.Moving boxes - m3TotalAttic Total - m3BathroomWashing machinePlease enter a number greater than or equal to 0.Washing machine - m3DrierPlease enter a number greater than or equal to 0.Drier - m3ClosetPlease enter a number greater than or equal to 0.Closet - m3Moving boxesPlease enter a number greater than or equal to 0.Moving boxes - m3TotalBathroom Total - m3OtherVacuum cleanerPlease enter a number greater than or equal to 0.Vacuum cleaner - m3Ironing boardPlease enter a number greater than or equal to 0.Ironing board - m3TotalOther Total - m3VehiclesMotorbikePlease enter a number greater than or equal to 0.Motorbike - m3CarPlease enter a number greater than or equal to 0.Car - m3TotalVehicles Total - m3Sports equipmentSurfboardPlease enter a number greater than or equal to 0.Surfboard - m3Diving gearPlease enter a number greater than or equal to 0.Diving gear - m3TotalSports equipment Total - m3Shed, Garage, GardenWork benchPlease enter a number greater than or equal to 0.Work bench - m3Closet(s)Please enter a number greater than or equal to 0.Closet(s) - m3ToolsPlease enter a number greater than or equal to 0.Tools - m3Children bicycle(s)Please enter a number greater than or equal to 0.Children bicycle(s)- m3Adults bicycle(s)Please enter a number greater than or equal to 0.Adults bicycle(s)- m3Garden setPlease enter a number greater than or equal to 0.Garden set - m3Garden chairsPlease enter a number greater than or equal to 0.Garden chairs - m3Garden furniturePlease enter a number greater than or equal to 0.Garden furniture - m3Garden furnishPlease enter a number greater than or equal to 0.Garden furnish - m3BarbequePlease enter a number greater than or equal to 0.Barbeque - m3ShelvesPlease enter a number greater than or equal to 0.Shelves - m3WoodPlease enter a number greater than or equal to 0.Wood - m3WheelbarrowPlease enter a number greater than or equal to 0.Wheelbarrow - m3Step ladderPlease enter a number greater than or equal to 0.Step ladder - m3PotsPlease enter a number greater than or equal to 0.Pots - m3PlantsPlease enter a number greater than or equal to 0.Plants - m3Moving boxesPlease enter a number greater than or equal to 0.Moving boxes - m3TotalShed, Garage, Garden Total - m3TotalTotal volumePhoneThis field is for validation purposes and should be left unchanged.