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
Pick-up Location:
Company Name:
Contact Name
Address:
Zip-Code:
Phone:
Fax: (Option)
Levels of Service:
Type of Pieces:
# of Pieces:
Total Weight:
Type of Vehicle preferred:
DELIVERY ADDRESS
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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