ORDER  FORM
CUSTOMER PLACING ORDER					Customer  ID #		Carrier Type
Contact Name:
Contact Phone: (       )
Email:
Street:
City:
State:		Zip:			1-800-301-5222   954-791-4764   954-791-4768 Fax
ORIGIN INFORMATION					DESTINATION INFORMATION
Contact Name:					Contact Name:
Contact Phone: (       )					Contact Phone: (       )
Other Phone: (       )					Other Phone: (       )
Other Phone: (       )					Other Phone: (       )
Email:					Email:
Street:					Street:
City:					City:
State:		Zip:			State:		Zip:
VEHICLE INFORMATION					VEHICLE READY DATE		/          /
Last 6 of your VIN       (Vehicle Identification Number)		Year	Make                               (ex: Ford, Chevy)		Model                                   (Ex: Taurus, Camaro)		Color	Shipping Cost
					Deposit (Refundable, See Agreement)
VEHICLE RUNNING CONDITION					Total Due Upon Delivery
* VEHICLE MOVES UNDER IT'S OWN POWER
* VEHICLE HAS WORKING BRAKES					PAYMENT TYPE  (check one)
* VEHICLE CAN BE STEERED					* CASHIERS CHECK		* DISCOVER
* VEHICLE HAS NO OTHER ISSUES					* VISA		* AMERICAN EXPRESS
OTHER ISSUES:					* MASTER CARD		* CHECK BY PHONE
						CREDIT CARD NUMBER
NAME ON CREDIT CARD
CARD HOLDER'S BILLING ADDRESS					EXPIRATION DATE		SEC
Card Holder's Signature (If Different than Customer):X
I have received, read, and understand the Shipping Agreement General Provisions of Car Freight. I agree to the Shipping Agreement and I agree to pay the above amount. I understand that my deposit is refundable under the conditions in the Shipping Agreement. I understand that the COD amount must be paid upon receipt of the car, and that only Cash, Money Order, or Cashiers Checks are accepted.
Customer's Signature X							Date
Mail To:					Fax To:	954-791-4768