At Your Service Transportation, Inc.

Delivery Service Order Form

For any product or special items.

Items with * must be filled out. If your browser has an auto fill you can use it for future orders.
Are you currently working with a Bekins agent? If so who:
Date:
*Company Name:
*Your Name:
*Telephone:
*E-mail:
*Repeat Your E-mail:
*Shipping From: Phone:
*Origin Address: Suite No.
*Origin (City) (State) * (5 digit Zip) *
*Ship To: Phone:
*Destination Address: Suite No.
*Destination (City) (State) * (5 digit Zip) *
*Destination Contact: Phone 2:
Payment Information
Prepay
COD
Credit Card We will call you for information.
Bill to: Company Name: Current client or approval required.
Item Information
*Product Shipping:
*Number of Pieces: * Total Weight: *
Size of pieces: Please use inches. Include packaging type in description. Crate, box, pallet, etc.
Pc.1 (L x W x H): xx* Weight: * Description *
Pc.2 (L x W x H): xx Weight: Description
Pc.3 (L x W x H): xx Weight: Description
Pc.4 (L x W x H): xx Weight: Description
Pc.5 (L x W x H): xx Weight: Description
Pc.6 (L x W x H): xx Weight: Description
Additional Insurance Requested for the Declared Value of $ Default coverage is 60 cents per pound of item.
Residential Pick Up: Yes Residential Delivery: Yes
Service Required
on Delivery:		 Inside Placement Yes How many stairs Requires Assembly Yes
Special Instructions:
Please print this page for your records before submitting.

After submitting your order please call us at 888-617-5540
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