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Name
First Name
Telephone
eMail*
departure
Starting date
Adress departure
Postal code
 City
Stages

elevator
Observations

arrival
Date arrival
Adresse arrival
Postal code
 City
Stages

elevator
Observations
Detail of the operations
Disassembling reassembly of furniture
Emballge crockery
Supply of the paperboards
Packing clothing suspended
Furniture depository
 so yes: duration envisaged

Value of furniture

volume in m3

estimated by:
Comments
Declared value

How knew us?
Internet
Other To specify:

I validate information* : yes