Moving Company Sample Delivery Information

Shipper / Customer _______________________________

Delivery address _________________________________

City_____________________ State ______ zip_________

Walk Up ? What Floor? _______  House? ________        Elevator? _______

Receiver Cell number______________________________

Receiver Tell. number_____________________________

Other contact ____________________________________

E-mail address ___________________________________

When is the Earliest Date you’ll be ready for delivery ______

A delivery attempt will be made on or after the date you gave us, if you will not be ready to accept the shipment at those dates your items will be placed in the nearest storage and a Redelivery Charge will apply.

Is there a trailer (53’ foot) access at Destination? _________

Other notes:

________________________________________________

Balance (COD) Cash on Delivery $ ____________________

Forman name __________ Number of blankets __________

All charges to be paid in Cash or Postal Money Order, Before shipment is relinquished by carrier.

Customer Signature ____________ Date _______

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