Personal information

Name (compulsory)

E-mail (compulsory)

Tel.

Fax.

Where are you moving from?

Origin address

Origin city

Postal code

Size of the appartment (m2)

Approximate carrying distance

Floor from ground level

Elevator available?

Moving to destination

Destination address

Destination city

Postal number

Size of appartment (m2)

Approximate carrying distance

Floor from grounf level

Elevator available?

Other information

Removal date

Insurance

Additional information

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