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Required fields are in bold
***NOTE: All high-value items must have an approp-
riate Declared Value (DCL) noted at the time you
place your order. Also, we will not leave valuable
packages unattended without your permission.
Order Form
Name:
Phone:
Email/Text:
Switch Pickup and Delivery (Flip)
Pickup (Stop1) Address
Destination
Name
Address
Room
City
State
DC
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
NE
NF
NH
NJ
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QB
RI
SA
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
YK
Country
USA
Argentina
Brazil
Canada
China
Finland
France
Germany
India
Italy
Japan
Mexico
Norway
Pakistan
Portugal
Russia
Spain
UK
Zip
Contact
Phone
Email
Residence
Name
Address
Room
City
State
DC
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
NE
NF
NH
NJ
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QB
RI
SA
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
YK
Country
USA
Argentina
Brazil
Canada
China
Finland
France
Germany
India
Italy
Japan
Mexico
Norway
Pakistan
Portugal
Russia
Spain
UK
Zip
Contact
Phone
Email
Okay To Leave
Residence
Notes:
Service Items
Pieces
Ttl Weight
?
Ready Time
Now
12:00AM
12:15AM
12:30AM
12:45AM
1:00AM
1:15AM
1:30AM
1:45AM
2:00AM
2:15AM
2:30AM
2:45AM
3:00AM
3:15AM
3:30AM
3:45AM
4:00AM
4:15AM
4:30AM
4:45AM
5:00AM
5:15AM
5:30AM
5:45AM
6:00AM
6:15AM
6:30AM
6:45AM
7:00AM
7:15AM
7:30AM
7:45AM
8:00AM
8:15AM
8:30AM
8:45AM
9:00AM
9:15AM
9:30AM
9:45AM
10:00AM
10:15AM
10:30AM
10:45AM
11:00AM
11:15AM
11:30AM
11:45AM
12:00PM
12:15PM
12:30PM
12:45PM
1:00PM
1:15PM
1:30PM
1:45PM
2:00PM
2:15PM
2:30PM
2:45PM
3:00PM
3:15PM
3:30PM
3:45PM
4:00PM
4:15PM
4:30PM
4:45PM
5:00PM
5:15PM
5:30PM
5:45PM
6:00PM
6:15PM
6:30PM
6:45PM
7:00PM
7:15PM
7:30PM
7:45PM
8:00PM
8:15PM
8:30PM
8:45PM
9:00PM
9:15PM
9:30PM
9:45PM
10:00PM
10:15PM
10:30PM
10:45PM
11:00PM
11:15PM
11:30PM
11:45PM
Ready Date
0
Today
Sat Apr 20
Sun Apr 21
Mon Apr 22
Tue Apr 23
Wed Apr 24
Thu Apr 25
Fri Apr 26
Sat Apr 27
Sun Apr 28
Mon Apr 29
Tue Apr 30
Wed May 1
Thu May 2
Fri May 3
Sat May 4
Sun May 5
Mon May 6
Tue May 7
Wed May 8
Thu May 9
Fri May 10
Sat May 11
Sun May 12
Mon May 13
Tue May 14
Wed May 15
Thu May 16
Fri May 17
Sat May 18
Sun May 19
Mon May 20
Tue May 21
Wed May 22
Thu May 23
Fri May 24
Sat May 25
Sun May 26
Mon May 27
Tue May 28
Wed May 29
Thu May 30
Fri May 31
DCL Value
?
Vehicle
--Unassigned--
Bike
Car
Minivan
Cargo Van
Truck
Service Summary
Service:
--Unassigned--
Regular
Rush
DoubleRush
Pkge Type:
--Not Specified--
Env-Pkg
Small Item(Roll)
Box-Trunk
Filings
Electronics
Large Item(Pallet)
Ready Time:
Ready Date:
Due Time:
Due Date:
Amount:
Order References
CompanyName
Keywords
CardHolder
Invoice
Billing Information
Payment Options
Credit Card
Visa
MasterCard
American Express
Discover
Email Notification
Send E-Mail or Text Message To:
When shipment is:
--None--
Created
Delivered
Pickedup
--None--
Created
Delivered
Pickedup
--None--
Created
Delivered
Pickedup
I agree to the company Terms and Conditions.
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