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Auto transport home >> Auto car shipping order form
Sales Person:
SHIPPING ORDER - BILL OF LADING
                        FIRST DATE CAR AVAIL. FOR TRANSPORT:  *
THIS ORDER FROM
Name: Phone: Email:
Business Phone: Cell Phone: Fax:
PICK UP CAR FROM
Name: Home Phone: Cell Phone: Business Phone:
Address: City/State/Zip:  
DELIVER CAR TO
Name: Home Phone: Cell Phone: Business Phone:
Address: City/State/Zip:  
CAR DESCRIPTION
Registered Owner or Leesee:
Car Make/Model/Year:
 /  / 
Lic. Plate Number/St:
 / 
Color:
   ADDITIONAL INFORMATION AND PHONE NUMBERS FOR PICK UP OR DELIVERY:
   
 CHECK: Sedan   Van   Jeep   SUV   P/Up Truck   Inoper. Veh., refer to Article #4
  Oversize Veh., see #4   Luggage: Yes   No (refer to articles 6 and 7)   Overseas (refer to article #8)

 Regular Price
  *

 Cash Discount Price
  *

 Additional Services
  

 Total:
  

-- Select how you are going to pay--

Check    Visa    MC    Am. Ex.    Disc. *
Full Payment with order or
$200 deposit, per vehicle (required)
Balance cash or cashiers check on delivery.
Full payment by credit card.

(Rate quoted includes 4% discount for cash payment. Credit Card customers and billing accounts will be charged full amount. Refer to article #4)

Card No.:        Exp. Date:          CVV Number:  
 
(numbers only, no spaces)
 

Card Holder:  Auth. Signature X ______________________


How did you hear about our service?

I have read and agree to the contract terms as an integral part of this order.


Name and Date: _______________________________________

X ___________________________________________________

Owner's or Shipper's Signature

INSTRUCTIONS TO PRINT ORDER FORM:


    1. COMPLETE THE FORM ON THIS SCREEN.

    2. CLICK PRINT BUTTON BELOW.

    3. SIGN AND FAX/SCAN TO: 877-859-4500.

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