RETURNING CUSTOMER
No shipper information needed if
you were given a Customer Number
Customer Number:
SHIPPER'S / NEW CUSTOMERS BILLING INFORMATION
Billing Name:
Billing Address:
Billing City, Zip, State:
Email Address:
Phone Number:
Contact Name:
PICK-UP LOCATION
IF YOU HAVE MORE THEN ONE DELIVERY LOCATION, COPY
AND PASTE INFORMATION IN LARGE BOX BELOW. FOR
SINGLE DELIVERY, FILL IN INFORMATION HERE
Business
Residential
Hospital
Clinic/Doctors Office
City/State Building
Airport
Hotel/Motel
Cruise Ship
Other
Pick-up Location:
Company Name:
Contact Name
Address:
Zip-Code:
Phone:
Fax:
(Option)
Priority: (Immediate Delivery, Point to Point)
1hr. ( P/U and Delivery within 1hr. of call)
2hrs. (P/U and Delivery within 2hrs. of call)
3hrs. (P/U and Delivery within 3hrs. of call)
AM/PM: (Ready by 9:00am for Pickup and Deliver by 5:00pm
Levels of Service:
Letter
Box
Other/ Mixed items
Type of Pieces:
1-5
6-15
over 15
# of Pieces:
1-10 lbs
11-25 lbs
26-75 lbs
76-100 lbs
100-200 lbs
200-500 lbs
over 500 lbs
Total Weight:
ANY VEHICLE
Car
Sm Cov P/U Mini Van
Cargo Van
24ft Strt Truck
Type of Vehicle preferred:
DELIVERY ADDRESS
Business
Residential
Hospital
Clinic/Doctors Office
City/State Building
Airport
Hotel/Motel
Cruise Ship
Other
Deliver Location:
Contact Name:
Address:
Zip-Code:
Phone:
Contact Name
FOR MULTI-DELIVERIES:
(Type-in or Copy paste below)
ADDITIONAL COMMENTS
Copyright © 1997 - 2009 Greenwalt Delivery Service, Inc.. All Rights Reserved.
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