Long Distance Delivery Information "*" indicates required fields In order to make your delivery as smooth as possible, please fill in the following information. Any wrong or missing information may cause a delay in the delivery time and additional charges may be applied.Customer's Name* Job Number*Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Type of Residence* Private House Elevator Building Walk Up 2nd Delivery Address? Yes No Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Type of Residence Private House Elevator Building Walk Up Flights of Stairs If house or walk up, indicate # of flights (1 flight = 7 steps) - Charges may applyIs there an access for a 53’ Trailer (72’ bumper to bumper) at all delivery locations?* Yes No (Charges may apply)Would we be able to park within 75’ or less from your apartment / house door?* Yes No (Charges may apply)If no, how far away will be able to park? Alternate ContactsPhone Number 1*Phone Number 1Phone Number 1Alternate Contacts - Name & Phone*PLEASE NOTE: Our services/rates are based on our ability to deliver your shipment at anytime within the delivery window listed in the contract with notice by 6pm day prior to the arrival. If you do have restrictions on the delivery you must notify our office in writing prior to setting up the 1st available delivery date, AND you must receive a written confirmation back about the approval of the restrictions. Any restriction on the hours and/or days will void the delivery window that is set in the contract and will delay the delivery dates and may require additional charges.I understand* I understand 1st available date that I will be able to accept my shipment is (NOTE: Cannot Select Today's Date): Select Date* MM slash DD slash YYYY NOTE: Cannot Select Today's DateThe driver will contact you with the delivery information by 6pm on the day prior to the delivery. Mid-West & East Coast delivery, from the 1st available delivery date (specified above): 1-14 business days. West Coast, from the 1st available delivery date (specified above): 1-21 business days. All deliveries are made on a flexible basis, and the delays caused by weather, acts of God, civil unrest, and other events beyond the control of Elite Moving & Storage Inc. shall not be the responsibility of Elite Moving & Storage Inc.I understand* I understand The balance due should be paid before unloading, by cash or postal money order only. Please have your balance ready I understand* I understand Without the payment by cash or postal money order we will not unload the shipment. In the event of the customer’s inability to receive the shipment at the time of delivery, the shipment will be placed in storage and will be redelivered on a later date, at customer’s expense.I understand* I understand I have read carefully the long distance delivery info and I agree to the information provided herein. 1) Flights and Stairs - In a single family home, Multi-family home and apartment building, one (1) flight is seven (7) stairs. 1st flight (7 stairs) = Free | Each additional flight (of 7 stairs) = $75.00 2) Waiting Time - Anytime that the truck and/or crew are waiting idle for one hour or more, because of customer unpreparedness at the agreed upon pick up time. $150.00 per hour per vehicle | $1,500.00 overnight waiting (7pm-7am) 3) Long Carry – 75 feet from the truck/trailer to the entrance of the living quarters: includes parking lots, crossing lawns, lobby and hallway in apartments building. It is 100% at the discretion of the driver to decide if he fits SAFELY in “one way” and narrow streets. 1st 75’ Feet = Free | Each additional 75’ feet = $75.00 4) Shuttle - When the truck cannot fit safely in the alley or street, it is at the driver’s discretion whether to conduct a long carry service or use a smaller size truck (shuttle) in order to get as close to the residence as possible. Shuttle rates of $1.00 per cubic foot will apply (i.e. 325 cubic feet = $325)I have read and understand the terms outlined above.* Your legal name* Your email address* Sign Here* Δ
