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Value Card Alliance Customer


Customer Information*
Are You Needing Emergency Services? 1)Yes, I Need Service As Soon As Possible! 2)Yes, I Need Service Today! 3)Yes, I Need Service Tomorrow/Next Day! 4)No, I Don’t Need Emergency or Next-Day Service.
What Service(s) Do You Need? (Check All That Apply) *
1)Labor Service Only (No Moving Truck Needed) 2)Moving Service (Includes Truck) 3)Delivery Service (1-6 Large Items) 4)Safe Relocation Service 5)Piano Relocation Service 6)Pool Table Relocation Service 7)Jacuzzi/Hot Tub Relocation Service 8)Junk Removal/Location Cleanup Service 9)Office/House Cleaning Service 10)Carpet/Tile Cleaning Service 11)Water Cleanup Restoration Service
Number of Men Requested*
Type of Structure Service(s) at Origin*
Structure Information
Overall Square Feet of Structure at Origin*
Number of All Rooms at Origin: *
Features of Structure at Origin*
(Distance, Access, etc.)
Type of Structure at Destination*
Overall Square Feet of Structure at Destination*
Features of Structure at Destination*
(Distance, Access, etc.)
Estimated Number of Boxes
Service(s) Information
Level of Packing/Unpacking Needed*
Estimate Number of Large Items to Be Moved (Anything Larger Than a Night Stand)*
Special Items Included in Service (Check All that Apply*
(List Anything That You Haven't Listed Already – Odd-Shaped or Hard-to-Box/Pack Items)
Level Assembly/Disassembly Needed*
1)A Little Bit of Assembly/Disassembly 2)A Mild Amount of Assembly/Disassembly 3)A Lot of Assembly/Disassembly 4)Everything Needs to Be Assembled/Disassembled 5)No Assembly/Disassembly Needed at All
What will be your Preferred Method of Payment (Check All that Apply)
1)Cash 2)Value Card Alliance Barter Points 3)Credit/Debit 4)Check 5)Money Order 6)Other
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