Survey Request

Fill in the survey provided below to begin so that we may better serve you.
Name: 
Email Address: 
How did you find our web site?
If Other: 
Residential Phone: 
Business Phone: 
Fax: 
Moving From: 

USA Other: 

Address: 
County: 
City: 
State: 
ZIP: 
Moving To: 
USA  Other: 
City: 
State: 
 
Approximate Moving Date: 
Will destination residence  
be ready by time of move? 		 Yes  No 
Will temporary storage be needed?  Yes  No 
Type of Move:  Employer-Paid  Self-Paid 
If employer-paid, employer name? 
Currently living in: 
Number of Total Offices:
Number of Total Rooms:
Number of Bedrooms:
Number of Major Appliances: 
Number of Flights of Stairs: 
Size of Residence (sq. ft.): 
Number of Adults: 
Number of Children: 
Ages of Children: 
Moving to: 
Have you previously moved with Barnes Van Lines? Yes  No 
 

Special Concerns or Requests: