Survey Summary
Customer Information
Shipper Name:
Julie Betts
Email:
Survey Date:
Origin Address:
Destination Address:
Items Inventory
Description
Qnt.
Volume (CFT)
Weight (LBs)
Comment
Room
Land
Bed, Double Size
2
140
980
Extra Stop
Bookcase
1
24
168
Extra Stop
End Table
2
10
70
Extra Stop
Tote, Medium
25
125
875
Extra Stop
Total
299
2093
Owner Signature
____________________
Cartons
Box Name
Quantity
1.5 carton
0
3.0 carton
0
4.5 carton
0
6.0 carton
0
Dish packs
0
Mirror cartons
0
TV cartons
0
StandUp Wardrobe
0
Lamp Carton
0
Mattress (single)
0
Mattress (Double)
0
Mattress (Queen)
0
Mattress (King)
0
Flat Wardrobe
0