Acc #
User Name
Password
Request a Pick up
[*]required info
Courier Service Billing Information
Client Code*
Billing Reference*
Company Name*
Telephone*
Courier Pick Up Information
Pick Up From*
Street Address*
City*
State*
Zip Code*
Courier Delivery Information
Deliver To*
Street Address*
City*
State*
Zip Code*
Instructions for Messenger
Who do we see for pick up ?*
If we are delivering to a residence is it OK to leave the package?
YES
NO
Round Trip
YES
NO
Type of Messenger Service (requests for non stops must be called in)
Regular
Call When Delivered
YES
NO
Other Information, Including Request Delivery Time*
I understand and agree to the following terms:
The above is true and submitted for the purpose of opening an account. This account will be billed twice a month and payment is due on receit.
Your Name & Title*
Owner's Name
Email*
Company Website
Ph.323-969-0000 Fx. 323-851-9992
Los angeles :: Orange County :: Hollywood :: Burbank
Santa Monica :: Culver City
©2006 Premier Eagle All Rights Reserved.
uscity.net
Website Developed by Dual
-X