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Secure Transaction

Shipping Contract For Pak Mail Store Affiliates
After you have received your quote, the next step is to complete the transaction by providing payment and transport information via our secure online form (SSL). If you would prefer to submit your order offline via email or fax, please download the editable PDF form. If you have not received your quote, please call Lynn at 561-843-4390. If at any time you have any questions , please call our Sales Professionals at 561-843-4390.
Pak Mail Store Number:
Name:
Store Address:
City and State:
Your Contact Numbers (Store,Cell):
Price Quoted:
 
Customer Information:
( This is the individual you are working with. )
Name:
Home Address:
Email Address:
Home Phone Number:
Cell Phone Number:
Work Phone:
Salesperson:
Address, City and State:
Pick Up Zip Code
 
Today's Date:
07-01-09
Pickup From:

VEHICLE TO SHIP:
Year:
Make:
Model:
 

DELIVERY SPECIFICATIONS:
Location Name :

Contact Name:
Address:
City:
State:
Zip:
Additional Delievery Contact Names and Phone Numbers:
Work Phone:
Other Phone:
CARRIER TYPE:
Open
CONDITION OF VEHICLE:
Operates on own power
Does NOT operate on own power

TOTAL AMOUNT DUE :
$
TOTAL AMOUNT DUE
Payment will be made via the credit card information provided. You will be charged the full amount as stated in your quote and referenced above. This will be considered payment in full and all payments to individual truckers will be made on your behalf by All Source Auto Transport. Your credit card will be charged after your car has been successfully loaded and enroute.

Should this order be cancelled, for any reason, after being assigned to a
Carrier, an administrative charge of $200.00 will be assessed. This fee
will be in addition to any other charges relative to shipment, i.e., storage
charges, pick-up fees, ip fees, etc.

PAYMENT INFORMATION:
Visa
Mastercard
Discover
American Express
 
Is the cardholder the vehicle shipper?
Yes      No
Do you have permission to use the card?
Yes      No

Credit Card Number
Expiration (xx/xx)
CVV2
Name on card
Billing Address
Special Instructions:
TERMS AND CONDITIONS

Click here to print Terms and Conditions
Please print the above section " Terms and Conditions" for your customer to sign and fax it to us at: 866-778-3364.
I accept the above terms and conditions.
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allsourcetransport.com Glades Rd Boca Raton, FL 33434
Phone: 561-843-4390 Fax: 866-778-3364