Account Application - Quick Premier Delivery Service

Company Name

DBA (if different)

Address

City

State

Zip Code

Fax

E-Mail

Website

Accounts Payable Contact

Billing Address

City

Zip

State

Billing E-Mail:

Federal Tax ID#

How many deliveries per week?

Vehicle Size

Description of item(s)

How did you hear about us?

Print Full Name

Direct Phone Number

I agree that the above information is true and correct. I am an authorized person by the company listed above to make decisions on its behalf.

I understand that the liability for loss or damage during the entire delivery process is limited to $100.00.

I understand in the chance that the pickup person(s) or drop off recipient(s) is not available without prior notice, delivery will be charged as complete and any request for return of items or re-attempt will be an additional full delivery fee charge unless prior arrangements are made with QPD.

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