New Page 3

Pickup Request
FROM		DESTINATION
Name or Customer No.		Name
Address:		Address:
City		City
State:		State:
Zip Code:		Zip Code:
Phone:		Phone:
FAX:
DESCRIPTION
Weight:		Pieces:
Special Instructions
Time Ready:		Would you prefer confirmation by: E-mail: or Phone: Confirmation will be provided within 15 - 20 minutes.
Closing Time:
Date: (if other than today)
NOTICE TO CUSTOMER: Same day service must be submitted prior to 11 AM
(Exceptions must be phoned in - 708-496-3300)