
You can print this form and store for your
records.
| Quantity | Item | Date Purchased | Purchase Cost | Replacement Cost |
| ______ | Appliances | ____________ | ____________ | ____________ |
| ______ | Bathroom Scales | ____________ | ____________ | ____________ |
| ______ | Cabinets / Contents | ____________ | ____________ | ____________ |
| ______ | Carpets / Rugs | ____________ | ____________ | ____________ |
| ______ | Chairs | ____________ | ____________ | ____________ |
| ______ | Closed Contents | ____________ | ____________ | ____________ |
| ______ | Curtains / Drapes / Blinds | ____________ | ____________ | ____________ |
| ______ | Linens | ____________ | ____________ | ____________ |
| ______ | Floor Covering | ____________ | ____________ | ____________ |
| ______ | Mirrors | ____________ | ____________ | ____________ |
| ______ | Paintings, etc. | ____________ | ____________ | ____________ |
| ______ | Shelves | ____________ | ____________ | ____________ |
| ______ | Sideboard | ____________ | ____________ | ____________ |
| ______ | Sundries | ____________ | ____________ | ____________ |
| ______ | Toilettes | ____________ | ____________ | ____________ |
| TOTAL | ____________ | |||