Courier Service Order Form
Company Name?
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Type of Business?
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Completed by (your name):
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Complete Mailing Address:
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Phone Number (area code):
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Fax Number (area code):
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Email Address (for confirmation):
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Your Reference Name/ Number:
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Pick Up Date:
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Will Be Ready (after what time)?
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Pick Up Address:
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Pick Up Contact Name:
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Delivery Date:
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Desired Time (not guaranteed):
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Destination Address:
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Destination Contact Name:
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Destination Phone Number:
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Description of Item (be specific)?
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Delivery Item Height?
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Delivery Item Weight?
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Deliver Item to (select option):
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Any Resident
Any Employee
Destination Contact Only (waiting fees apply $10.00 hour)
Special Instructions:
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Additional Information:
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Signature (type name):
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Date Completed (type date):
*