New Customer Delivery Information Form

Any issues filling out the form? Please get in touch with us at contact@citypallets.ca

Date

Legal Name*

Trade Name

Authorized Contact Name*

Authorized Contact Title

Authorized Contact Telephone* Number

Authorized Contact Email*

secure

Delivery Address*

Purchasing Agent Telephone Number*

Purchasing Agent Name*

Purchasing Agent Email*

Second Contact Name

Second Contact Phone Number

Shipping/Receiving Hours*

Additional Comments

Do you have a dock level door?*
Do you have a forklift?*
Do you have a licensed forklift driver?*

I declare that the above information is true, correct and complete.

Signature (please use your mouse or finger to draw your signature in the box below)

Company