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Courier Service Billing Information
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| Client Code* |
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| Billing Reference* |
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| Company Name* |
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| Telephone* |
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Courier Pick Up Information |
| Pick Up From* |
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| Street Address* |
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| City* |
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| State* |
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| Zip Code* |
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Courier Delivery Information |
| Deliver To* |
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| Street Address* |
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| City* |
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| State* |
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| Zip Code* |
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Instructions for Messenger |
| Who do we see for pick up ?* |
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| If we are delivering to a residence is it OK to leave
the package? |
| YES NO |
| Round Trip |
| YES NO |
| Type of Messenger Service (requests for non stops must
be called in) |
|
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| Call When Delivered |
| YES
NO |
| Other Information, Including Request Delivery
Time* |
|
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I understand and agree to the
following terms:
The above is true and submitted for the purpose of
opening an account. This account will be billed twice a month and payment is due
on receit. |
| |
| Your Name & Title* |
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| Owner's Name |
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| Email* |
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| Company Website |
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