Customer Household Inventory
Contact Information
First Name
Last Name
Home Phone
Mobile Phone
Work Phone
Email
Move Date
Move Type
Single Room
Studio
1 Bedroom Apartment
2 Bedroom Apartment
3+ Bedroom Apartment
1 Bedroom House
2 Bedroom House
3 Bedroom House
4+ Bedroom House
Addresses
Origin Address
Address
Address Line 2
City
Province
Manitoba
Alberta
British Columbia
Saskatchewan
Ontario
Quebec
Newfoundland/Labrador
Prince Edward Island
Nova Scotia
New Brunswick
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
Country
Canada
Destination Address
Address
Address Line 2
City
Province
Manitoba
Alberta
British Columbia
Saskatchewan
Ontario
Quebec
Newfoundland/Labrador
Prince Edward Island
Nova Scotia
New Brunswick
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
Country
Canada
USA
Other
Other Information
Is this move with EIA?
No
Yes
Next Step