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YOUR COMPANY NAME

Email:*

STREET ADDRESS*

SUBURB*

STATE*

POSTCODE*

TELEPHONE*

FAX

MOBILE*

CONTACT NAME (TITLE)*

OTHER CONTACT

SENDER: Company Name*

Contact Person*

Phone*

Mobile*

Email*

Fax

Pick up Address*

SENDER:Suburb*

SENDER:State*

SENDER:Postcode*

Does Sender have Forklift and driver to Load? (Tick for Yes)

IF NO Forklift - Tailgate Load Pick up (Max 700kgs) (Tick for Yes)

IF NO Forklift - Hand Load Pick up (Max 700kgs) (Tick for Yes)

Is Pick up address a Private / Residential address? (Tick for Yes)

Height Restrictions at pick up site? (e.g. Max 3.7m High)

Truck Size/ Weight Restrictions at pick up? (e.g. Max 4.5t)

RECIEVER: Company Name*

RECIEVER: Contact Person*

RECEIEVER: Phone*

RECEIVER: Mobile*

RECEIVER: Email*

RECEIVER: Fax

RECEIVER: Delivery Address*

RECEIVER: Suburb*

RECEIVER: State*

RECEIVER: Postcode*

Does Reciever have Forklift and driver to Unload (Tick for Yes)

IF No Forklift - Tailgate Unload Delivery (Max 700kgs) (Tick for Yes)

IF No Forklift - Hand Unload Delivery (Max 700kgs) (Tick for Yes)

Is the drop off address a private / residential address? (Tick for Yes)

Height Restrictions? (e.g. Max 3.7m High)

Truck Size / Weight Restrictions? (E.g. Max 4.5t)

Quantity*

Packing Type

Pallet Box Crate Carton Other

Description of Goods

Length*

Width*

Height*

Weight*

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