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