Couriers on Demand

PO Box 270414

Dallas TX 75227

(214) 333-2869

kdb@couriersondemand.com

http://www.couriersondemand.com

Order#
Date / Time

09/26/2007 09:39 PM
Driver#
Your Name   Your Phone  
Your Email    
Bill to Name        
Bill to Company        
Bill to Address        
Bill To City Bill to State Bill To Zip
Bill To Phone Bill To Email
Pick Up Name        
Pick Up Company        
Pick Up Address        
Pick Up City Pick Up State Pick Up Zip
Pick Up Phone Pick Up Email
Delivery Name        
Delivery Company        
Delivery Address        
Delivery City Delivery State Delivery Zip
Delivery Phone Delivery Email
Number of Pieces Weight

lbs
Description of Package Value* $  

Please Read

After you have completed this for but before clicking the submit button below, please print three copies of this page one copy will be your pick up record, one copy will be the delivery receipt and one copy will be for Couriers on Demand.

 

 
* Every Shipment is insured up to $50.00 unless value is declared and additional insurance is purchased at time of order. Claims must be made within 24 hours of delivery.
       
Received by   Date   Time