BVL

Survey Request

Fill in the survey provided so we may better serve you.
Name

First NameLast Name
E-mail
How did you find our website
If other explain
Residential Number

Area CodePhone Number
Business Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Moving from
If other explain
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Moving to
If other explain
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Approximate Moving Date

MonthDayYear
Will destination residence be ready by time of move?

YesNo
Will temporary storage be needed?

YesNo
Type of Move

Employer-PaidSelf-Paid
If employer-paid, employer name?
Currently living in

ApartmentHouseOther
Number of total offices
Number of total rooms
Number of total bedrooms
Number of major appliances
Number of flight of stairs
Size of residence (sq. ft.)
Number of Adults
Number of Children
Age of Children
Moving to

ApartmentHouseOther
Have you previously moved with Barnes Van Lines?

YesNo
Special concerns or requests
Should be Empty: