Form Center

2. Name*
3. Address*
5. Medium Goods

   1. Kitchen Chair
   2. Coffee Table
   3. End Table
   4. Mattress
   5. Headboard
   6. Footboard
   7. Blanket chest/trunk
   8. Bed Rails/ Frame
   9. Box Spring
   10. Stroller
   11. Water Bed
   12. Ceiling Light Fixtures
   13. Ceiling Fan/ Floor Fan
   14. Chandelier
   15. Speakers
   16. Garbage Can
   17. Bike
   18. Trash Can
   19. Garbage Bag (per bag)
6. Medium/Heavy Goods

   1. Kerosene Heater
   2. Electric Heater
   3. Sofa
   4. Loveseat
   5. Recliners
   6. Entertainment Center
   7. Bookcase
   8. Dining Table
   9. Buffet
   10. Hutch
   11. Dresser
   12. Night Stand
   13. Desk
   14. Television
   15. Medicine Cabinet
   16. VCR Player
   17. DVD Player
   18. Stereos
   19. Lawn Mower
   20. Weed Eater
   21. Gas/Charcoal Grill
   22. Picnic Table
   23. Basketball Goal
8. Heavy Goods

   1. Refrigerator
   2. Stove
   3. Dishwasher
   4. Washer
   5. Dryer
   6. Air conditioner
   7. Humidifier
   8. De-Humidifier
   9. Freezer
   10. Microwave
   11. Sink
   12. Tubs
   13. Toilet
   14. Rug/Carpet Roll
   15. Swing Set
9. Large/Heavy Goods

   1. Water Heater
   2. Piano
   3. Organ
11. Signature:*
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