HALLWAYS

You can print this form and store for your records.

Quantity Item Date Purchased Purchase Cost Replacement Cost
______ Carpets/Rugs ____________ ____________ ____________
______ Chairs ____________ ____________ ____________
______ Clocks ____________ ____________ ____________
______ Closed Contents ____________ ____________ ____________
______ Cupboard Contents ____________ ____________ ____________
______ Curtains/Drapes/Blinds ____________ ____________ ____________
______ Lamps ____________ ____________ ____________
______ Mirrors ____________ ____________ ____________
______ Floor covering ____________ ____________ ____________
______ Paintings, etc. ____________ ____________ ____________
______ Tables ____________ ____________ ____________
______ Shelves ____________ ____________ ____________
______ Sundries ____________ ____________ ____________
______ Vacuum cleaner ____________ ____________ ____________
TOTAL ____________

® Registered Trademark of Optimum Group Inc. Copyright © 1996.   Legal notice.