Name
*
user
Make
*
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Model
*
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Bench?
*
Yes
No
Player Piano?
*
Yes
No
Grand
Vertical
Length (Grand)
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Height (Vertical)
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Additional Information
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Pick-Up Location
Contact Name
*
user
Contact Phone
*
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Contact E-Mail
*
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Address
*
address
Address 2
address
City
*
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State
*
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Zip
*
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Stairs?
*
Stairs?
Yes
No
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If Yes, Number of Steps?
*
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If Yes, Inside?
*
None
Straight
Curved
If Yes, Outside?
*
None
Straight
Curved
Drop-Off Location
Contact Name
*
user
Contact Phone
*
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Contact E-Mail
*
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Address
*
address
Address 2
address
City
*
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State
*
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Zip
*
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Stairs?
*
Stairs?
Yes
No
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If Yes, Number of Steps?
*
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If Yes, Inside?
*
None
Straight
Curved
If Yes, Outside?
*
None
Straight
Curved
Delayed Delivery?
*
Yes
No
If Yes, please indicate deliver after date
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Best Way to Contact?
Phone
E-Mail
Best Time to Contact?
Anytime
9am-noon
noon-3pm
3pm-6pm
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