Eric's Shipping Service - http://www.machinemover.com

ERIC'S SHIPPING SERVICE - PRICING AND ORDERING FORM

SHIPPING METHOD

Domestic

Canada

International

ORIGIN
Name:
Address/City (no PO box):
State:	Zip/Postal Code:
Phone:	Evening Phone:
E-mail:

LOADING DOCK?

Business with loading dock

Business without loading dock

TRACTOR TRAILER ACCESS TO THE STREET?
Yes	No

IS PICKUP TRACTOR TRAILER ACCESSIBLE?

Residence ground floor pickup less then 75’ from parked truck and/or less then total of 5 steps

Residence ground floor pickup more then 75’ from parked truck and/or more then total of 5 steps

WILL ITEM NEED TO BE?

Crated(Additional Fee)

Bubble wrapped(Additional Fee)

Blanket wrapped(Included in Standard Quote)

Palletized(additional Fee)

WILL THE ITEM NEED TO BE ASSEMBLED/DISASSEMBLED?
Assembled	Both
Disassembled	Neither

DESTINATION

Name:

Address/City (no PO box):

State:

Zip/Postal Code:

Phone:

Evening Phone:

E-mail:

LOADING DOCK?

Business with loading dock

Business without loading dock

TRACTOR TRAILER ACCESS TO THE STREET?
Yes	No

IS DESTINATION TRACTOR TRAILER ACCESSIBLE?

Residence ground floor pickup less then 75’ from parked truck and/or less then total of 5 steps

Residence ground floor pickup more then 75’ from parked truck and/or more then total of 5 steps

WILL THE ITEM NEED TO BE ASSEMBLED/DISASSEMBLED?
Assembled	Both
Disassembled	Neither

DECLARED VALUES (For valuation coverage. If no insurance is required, please leave blank)

1.
2.
3.
4.

ITEM
Pinball	Jukebox	Arcade Video
Soda Machine	Player Piano	Stereo Speakers
Hosehold Items	Other (please specify):

TOTAL SHIPMENT WEIGHT
1.	Length	Width	Height
2.	Length	Width	Height
3.	Length	Width	Height
4.	Length	Width	Height
5.	Length	Width	Height

* Please note : These are rough estimate lists in order for our customers to get a good general idea of our itineary. For additional states, listings,or questions, please contact us directly.

TWO WAYS TO CONTACT ERIC OFFICE

CELL PHONE/VOICE MAIL 1-928-279-4224
E-MAIL AT ERIC@MACHINEMOVER.COM.

It is best to reach us by e-mail, as Eric is now spending the majority of his time on the road and e-mail gives us a working paper trail of all correspondence.

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Protected by the copyright laws of the United States and Canada and by international treaties.