9745 Sunset Drive Suite 215 Miami, FL 33173 Ph. (305) 412-3494 Fax (305) 412-3081
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Your  Name:  Date:            Address: Phone:             Purch Date  Approx. Cost  X Repl X Clean/Wash X Dry Cln FOYER                 Mirror        Replace   Clean/Wash     Console       Replace   Clean/Wash     Lamps       Replace   Clean/Wash     Floor Lamps        Replace   Clean/Wash     Flower vases       Replace   Clean/Wash     Candelabra (Many Candles)       Replace   Clean/Wash     Candle Sconces        Replace   Clean/Wash     Candle Sticks (Thin, Tapers)       Replace   Clean/Wash     Candleholders & Candles (Large)       Replace   Clean/Wash     Clocks       Replace   Clean/Wash     Figurines       Replace   Clean/Wash     Natural Plants       Replace   Clean/Wash     Silk Flower Arrangement       Replace   Clean/Wash     Silk Plants       Replace   Clean/Wash     Wall Art � Paintings       Replace   Clean/Wash     Wall Décor / Family Picture Frames       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     LIVING ROOM       Replace   Clean/Wash     Sofa / Loveseat        Replace   Clean/Wash     Coffee table       Replace   Clean/Wash     End table       Replace   Clean/Wash     Lamps       Replace   Clean/Wash     Floor Lamps        Replace   Clean/Wash     Flower vases       Replace   Clean/Wash     Candelabra (Many Candles)       Replace   Clean/Wash     Candle Sconces        Replace   Clean/Wash     Candle Sticks (Thin, Tapers)       Replace   Clean/Wash     Candleholders & Candles (Large)       Replace   Clean/Wash     Clocks       Replace   Clean/Wash     Figurines       Replace   Clean/Wash     Natural Plants       Replace   Clean/Wash     Silk Flower Arrangement       Replace   Clean/Wash     Silk Plants       Replace   Clean/Wash     Wall Art � Paintings       Replace   Clean/Wash     Wall Décor / Family Picture Frames       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     DINING ROOM       Replace   Clean/Wash     Dining Table   (Circle One)   Wood Glass Formica  Lacquer       Replace   Clean/Wash     No. Chairs       Replace   Clean/Wash     China Cabinet       Replace   Clean/Wash     Buffet       Replace   Clean/Wash     Mirror (Size)       Replace   Clean/Wash     Flower vases       Replace   Clean/Wash     Candelabra (Many Candles)       Replace   Clean/Wash     Candle Sconces        Replace   Clean/Wash     Candle Sticks (Thin, Tapers)       Replace   Clean/Wash     Candleholders & Candles (Large)       Replace   Clean/Wash     Clocks       Replace   Clean/Wash     Figurines       Replace   Clean/Wash     Natural Plants       Replace   Clean/Wash     Silk Flower Arrangement       Replace   Clean/Wash     Silk Plants       Replace   Clean/Wash     Wall Art � Paintings       Replace   Clean/Wash     Wall Décor � Family Picture Frames       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     KITCHEN        Replace   Clean/Wash     ELECTRICS       Replace   Clean/Wash     Blender *Brand                          *Serial #       Replace   Clean/Wash     Bread Maker *Brand                          *Serial #       Replace   Clean/Wash     Coffee Grinder *Brand                          *Serial #       Replace   Clean/Wash     Coffee Maker *Brand                          *Serial #       Replace   Clean/Wash     Coffeemaker *Brand                          *Serial #       Replace   Clean/Wash     Espresso Maker *Brand                          *Serial #       Replace   Clean/Wash     Food Processor *Brand                          *Serial #       Replace   Clean/Wash     Hand Mixer *Brand                          *Serial #       Replace   Clean/Wash     Juice Maker *Brand                          *Serial #       Replace   Clean/Wash     Pasta Maker *Brand                          *Serial #       Replace   Clean/Wash     Toaster *Brand                          *Serial #       Replace   Clean/Wash     Toaster Oven/Broiler *Brand                          *Serial #       Replace   Clean/Wash             Replace   Clean/Wash                                                                             APPLIANCES       Replace   Clean/Wash     Range  *Brand                          *Serial #       Replace   Clean/Wash     Refrigerator  *Brand                          *Serial #       Replace   Clean/Wash     Trash Compactor  *Brand                          *Serial #       Replace   Clean/Wash     Dishwasher *Brand                          *Serial #       Replace   Clean/Wash     Microwave *Brand                          *Serial #       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash                                                 Replace   Clean/Wash             Replace   Clean/Wash     LAUNDRY ROOM       Replace   Clean/Wash     Washer       Replace   Clean/Wash     Dryer       Replace   Clean/Wash     Water Heater       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash                                                                             OTHER       Replace   Clean/Wash     Canister Set       Replace   Clean/Wash     Cookbook Stand       Replace   Clean/Wash     Pot Rack        Replace   Clean/Wash     Spice Rack       Replace   Clean/Wash     Wine Rack        Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     COOKWARE:       Replace   Clean/Wash     Casserole Dish       Replace   Clean/Wash     Colander       Replace   Clean/Wash     Cookie Sheet       Replace   Clean/Wash     Double Boiler       Replace   Clean/Wash     Fruit Dehydrator        Replace   Clean/Wash     Kettle       Replace   Clean/Wash     Pressure Cooker       Replace   Clean/Wash     Quart Stockpot With Lid       Replace   Clean/Wash     Rice Cooker        Replace   Clean/Wash     Round Or Oval Dutch Oven With Cover        Replace   Clean/Wash     Saucepans With Lids        Replace   Clean/Wash     Skillets        Replace   Clean/Wash     Steamer Insert       Replace   Clean/Wash     Steamer Insert       Replace   Clean/Wash     Tea Kettle       Replace   Clean/Wash     Wok       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     CUTLERY       Replace   Clean/Wash     Bread Knife       Replace   Clean/Wash     Chef's Knife       Replace   Clean/Wash     Kitchen Shears       Replace   Clean/Wash     Paring Knife       Replace   Clean/Wash     Sharpening Steel       Replace   Clean/Wash     Steak Knives       Replace   Clean/Wash     Utility Knife       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     BAKEWARE:       Replace   Clean/Wash     Baking Dishes (Pie, Cake, Bread, etc.)       Replace   Clean/Wash     Casserole Dish       Replace   Clean/Wash     Colander       Replace   Clean/Wash     Cookie Sheet       Replace   Clean/Wash     Crepe Pan       Replace   Clean/Wash     Dutch Oven        Replace   Clean/Wash     Fondue Pot       Replace   Clean/Wash     Italian / Cuban coffeemaker         Replace   Clean/Wash     Large Roasting Pan And Rack        Replace   Clean/Wash     Mixing Bowls (Various Sizes)       Replace   Clean/Wash     Soufflé Dish       Replace   Clean/Wash     Steamer Insert       Replace   Clean/Wash     Tea Kettle       Replace   Clean/Wash     Wire Rack        Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     TABLEWARE       Replace   Clean/Wash     Table Size_________________       Replace   Clean/Wash     Napkins       Replace   Clean/Wash     Placemats       Replace   Clean/Wash     Table Cloths (Total, Everyday, Holiday & Fancy)       Replace   Clean/Wash     Table Runner       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     DINNERWARE       Replace   Clean/Wash     _____ # Place Settings        Replace   Clean/Wash             Replace   Clean/Wash     Bread Tray       Replace   Clean/Wash     Cake Platter       Replace   Clean/Wash     Candlesticks       Replace   Clean/Wash     Cereal Bowls       Replace   Clean/Wash     Chafing Dish       Replace   Clean/Wash     Chargers        Replace   Clean/Wash     Coffee Pot       Replace   Clean/Wash     Dinner Plates       Replace   Clean/Wash     Espresso Cups And Saucers       Replace   Clean/Wash     Gravy Boat And Stand       Replace   Clean/Wash     Mug Set       Replace   Clean/Wash     Pasta Bowls       Replace   Clean/Wash     Platters        Replace   Clean/Wash     Salad Bowls       Replace   Clean/Wash     Salad/Dessert Plates        Replace   Clean/Wash     Salt And Pepper Shakers       Replace   Clean/Wash     Saucers       Replace   Clean/Wash     Serving Bowl       Replace   Clean/Wash     Serving Platter       Replace   Clean/Wash     Serving Trays       Replace   Clean/Wash     Soup Bowls       Replace   Clean/Wash     Soup Tureen       Replace   Clean/Wash     Sugar Bowl And Creamer       Replace   Clean/Wash     Sushi Set       Replace   Clean/Wash     Tea Pot       Replace   Clean/Wash     Teacups       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     FLATWARE       Replace   Clean/Wash     Dinner Fork       Replace   Clean/Wash     Flatware Set       Replace   Clean/Wash     Knife       Replace   Clean/Wash     Salad Fork       Replace   Clean/Wash     Tablespoon        Replace   Clean/Wash     Teaspoon       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     CRYSTAL & GLASSWARE       Replace   Clean/Wash     Brandy Snifter: (Short Stem And Wide Foot)        Replace   Clean/Wash     Champagne Flute: (Taller/Thinner Than Wineglass)       Replace   Clean/Wash     Double Old-Fashioned Glass: Short Glass/No Stem       Replace   Clean/Wash     Highball Tall, Narrow Glass (Screwdrivers Glass)       Replace   Clean/Wash     Margarita Glassware: (Large Rim, Wide Bowl)       Replace   Clean/Wash     Martini Glass (Triangular Glasses)       Replace   Clean/Wash     Pilsner: (Pub Like Beer Glass)        Replace   Clean/Wash     Red Wine Glass (Larger "Bowls")       Replace   Clean/Wash     Standard Wine Glasses (White Wine Glass)        Replace   Clean/Wash     Water Goblet (Larger Bowls Than Wineglasses)       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     BARWARE        Replace   Clean/Wash     Corkscrew       Replace   Clean/Wash     Ice Bucket / ice pliers        Replace   Clean/Wash     Opener        Replace   Clean/Wash     Liquor Bottles        Replace   Clean/Wash     Wine Bottles       Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash             Replace   Clean/Wash     LINEN CLOSET:       Replace   Clean/Wash     Bath Towels       Replace   Clean/Wash     Hand Towels       Replace   Clean/Wash     Guest Towels       Replace   Clean/Wash   Dry Cln Washcloths       Replace   Clean/Wash   Dry Cln Sheet Sets       Replace   Clean/Wash   Dry Cln Pillowcases                Dry Cln Down Comforter       Replace   Clean/Wash   Dry Cln Bedcover       Replace   Clean/Wash   Dry Cln Mattress Pads       Replace   Clean/Wash   Dry Cln Blankets       Replace   Clean/Wash   Dry Cln Mattress Protector       Replace   Clean/Wash   Dry Cln Down Feather Comforter       Replace   Clean/Wash   Dry Cln Duvet       Replace   Clean/Wash   Dry Cln Cashmere Blanket       Replace   Clean/Wash   Dry Cln Blanket Warmer       Replace   Clean/Wash   Dry Cln Bed Skirt        Replace   Clean/Wash   Dry Cln Comforter        Replace   Clean/Wash   Dry Cln Comforter Sets       Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln         Replace   Clean/Wash   Dry Cln