House Clearance Services Form

Current address現住所

Destined Address引っ越し先が決まっている方

For undecided destinations
これから引っ越し先を探す方

Preferred location
Prefecture：
City/Ward ：

Departure Date引越し予定日

Departure day preference 1　
Departure day preference 2　

Items Inspection Date見積り希望日

Items Inspection day preference 1　
Items Inspection day preference 2　

Size of residentsお引越し人数

SingleFamily

Request Items for Resale買取希望

Requesting resaleNo items to sell

Japanese level日本語の能力

I can't speak at all　全然！I can speak a little　すこし…Can speak well　まぁまぁCan speak completely　ペラペラ！