One Time Order

ORDER PLACER DIFFERENT FROM PICKUP?* ORDER PLACER DIFFERENT FROM PICKUP?* YES NO

ORDERED BY

(COMPANY) NAME

CONTACT NUMBER

EMAIL

PICKUP INFO

PICKUP (COMPANY) NAME*

PICKUP ADDRESS*

PICKUP SUITE

PICKUP POSTAL CODE*

PICKUP CITY*

PICKUP EMAIL*

PICKUP CONTACT NAME*

PICKUP CONTACT NUMBER*

DELIVERY INFO

DELIVERY (COMPANY) NAME*

DELIVERY ADDRESS*

DELIVERY SUITE

DELIVERY POSTAL CODE*

DELIVERY CITY*

DELIVERY EMAIL

DELIVERY CONTACT NAME*

DELIVERY CONTACT NUMBER*

SERVICE & PACKAGE INFO

SERVICE TYPE* SERVICE TYPE* SUPER HOT (60 - 90 Minutes) HOT (2-HOUR SERVICE) RUSH (3-HOUR SERVICE) REGULAR (5-HOUR SERVICE) ECONO (NEXT BUISNESS DAY)

PACKAGE TYPE* PACKAGE TYPE* SKID BOX BAG ENVELOPE OTHER

NUMBER OF PIECES*

WEIGHT (lbs.)*

DIMENSIONS (WIDTH x LENGTH x HEIGHT in inches)*

Time when the Package is ready to be picked up*

COMMENTS