*Requested By:

*Date:

*Company Name:

*Phone #:

*Fax #:

*Email:

*Delivery Date:

*Pickup Date:

*Adjustment Date:

*Reschedule Date:

*Complex Name:

*Phone #:

*Delivery Address:

*Zip:

*Unit #:

*Floor(select one):

1st

2nd

3rd

4th

Claremont

Espresso

Maple/Triad

Sherwood

Highland Park Cherry

Bittersweet Pine

Matrix

Other

Upholstery: Sofa / Chair / Loveseat

1st Choice:

2nd Choice:

1-Bedroom

2-Bedroom

3-Bedroom

4-Bedroom

Master:

2nd Bedroom:

3rd Bedroom:

TV Tube style (select one):

19"

27"

TV HD Flat screen style:

19"

26"

32"

TV Stand

DVD Player

Microwave

Vacuum

Basic

Executive

Picture

Qty:

Plants

Qty:

Ficus Trees

Qty:

OTHER ITEMS: (1)

(2)

(3)

(select One):

Short Term

3-Month

6-Month

1-Year

Monthly Rental Rate:$Delivery/Adjustment Charge:$(plus applicable tax)