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Name
Phone Number
Email
Date
Time Slot
Select time slot
0800-1200
1300-1700
1800-2200
From Postcode
To Postcode
House Type
Bungalow
Flat
House
Number of Bedrooms
1
2
3+
If Flat, select the level
Select Level
Ground
1
2
3
4
5+
Please tick if lift is available
Additional Questions
Please tick if parking is available
Please tick if you will assist in the move
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