JTML Order Confirmation Form

(#328) 1581 Route 202, Pomona N.Y. 10970-2901( 845-517-0281, 845-517-0282 6

www.jtmlogistics.com / info@jtmlogistics.com

Shipping Order Confirmation Form

MPORTANT! Read First: Upon acceptance of our quotation, please print out the order confirmation form, together with the Shipping Terms and Conditions form, read it, sign both forms and fax it back. Please complete all fields as best as possible in order to ensure effective communication and service.

Load #

Please Check Shipment Option

Guaranteed to Go

Priority Pickup

*Order Name:

Vehicle availability Date:

*Owner Name:	Email:
* The Order name is the person or authority responsible for placing the shipping order. Owner name is owner of the vehicle.

Billing: Name and Address:

City:

State:

Zip:

Tel.Home:

Work:

Cell:

Fax:

Pickup From: Name and Address:

City:

State:

Zip:

Tel.Home:

Work:

Cell:

Fax:

Deliver to: Name and Address:

City:

State:

Zip:

Tel.Home:

Work:

Cell:

Fax:

Vehicle: Is in running condition ______not running with brakes _______not running no brakes______

Year:

Make:

Model:

VIN:

Payment Details: (Credit card payments will be charged an additional 3% to cover billing costs)

Please check payment option:

1. Overnight cashiers check for deposit or full payment to JTM Logistics Inc.
2. Pay in full by credit card
3. Deposit charged to credit card, balance paid COD by cashiers check or in cash (Preferred)

Amount Quoted :

Final Amount:

Charged Amount:

Paid:

Balance Due:

Credit card type:

Number:

Code:

Expiration Date:

Name on Card:

Card Billing Address:

I hereby accept and agree to the terms as set out on the order confirmation form. I also confirm and understand that the billing information on this order form including credit card details are correct and will be used towards the payment of my order by JTM Logistics. This order is only valid on condition that the Shipping Terms and Conditions form has also been signed and forwarded to JTM Logistics Inc..

Signed:

Date: