Delivery Order/ Quote Request

Billing Information

Account # Job Ref # Order Date
Billing Address Rm / Ste
City State Zip
Ordered by Phone
Email Address

Pick Up At:

Pickup Address Rm / Ste
City State Zip
To See Phone
Pick Up Date mm/dd/yyyy Pick Up Time hh:mm am/pm

Deliver To:

Delivery Address Rm / Ste
City State Zip
Attention Phone
Deliver On Date mm/dd/yyyy Deliver By hh:mm am/pm

Merchandise To Deliver:

Number of pieces
Total weight (if applicable)
Size / dimensions (if applicable)

Equipment, Personel, Instructions:

What size vehicle will be needed
Blankets required
Additional personnel needed
Will there be extra stops    If Yes, # of stops
Inside delivery
If not ground floor, are there
Do we need to unpack merchandise
and dispose of cartons
Will this be a Round Trip
If Yes, what will we be returning
Other special requests / instructions
C.O.D.    C H A R G E S :
C.O.D. Amount
Collect C.O.D. from
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