Job Starting Form


COMBINED AGREEMENT FOR MOVING SERVICES AND FREIGHT BILL LOCAL MOVE BILL OF LADING-PART I

CUSTOMER (SHIPPERS) IS REQUIRED TO READ THIS DOCUMENT CAREFULLY, INLUDING TERMS AND CONDITIONS, AND ASK FOR EXPLANTION OF ANYTHING NOT CLEAR OR INCONSISTENT WITH ANY PREVIOUS RESPRESENTATION. THIS WILL CONFIRM INSTURCTIONS AND AUTHORIZE THE MOVING SERVICES.

Job # :  
Date :  
Customer First Name :  
Customer Last Name :  
Phone :  
Email :  
Pick Up Address:
Floor :  
Elevator :  
Stairs :  
Delivery Address:
Floor :  
Elevator :  
Stairs :  
 
Flat Rate: $  
Estimated CF :  
Hourly Rate Cash :  
Hourly Rate Credit :  
# Trucks :  
# Movers :  
Valuation Declaration:

There are three options (3) available to cover loss or damage:

1) 60 cents per pound per article. This minimum coverage for lost or damaged items is based on 60 cents times the weight of the article. This coverage is provided at no additional charge   
2) Actual cash value. This option provides for lost or damaged based on actual cash value, including depreciation, at the time of loss or damage, up to the total dollar amount of value declared by you. You may be charged or this coverage. ___________ 
3) Full value protection. This option provides for the lost or damaged items based on current replacement value at the time of loss or damage, up to the total amount of valuation declared by you. This is subject to a deductible selected by you. You may be charged for this coverage. NOTICE: Coverage for loss and damage is limited to the actual cash value of losses up to the amount of $20,000 unless the shipper signing this agreement inserts in the space below another value. You may be charged for coverage provided other than $0.60 per pound per article. Shipper hereby releases the entire shipment to a value not exceeding $_____________  
4) If neither option 2 nor 3 is CLEARLY selected as indicated by customer’s initials or signature, customer agrees the default coverage shall be option 1.
Credit Card Authorization
I the undersigned, authorize Civic Van Lines, Inc, DBA Shleppers Moving & Storage to charge my credit card for the agreed amount on or after the indicated to my credit card provided. I certify that I am an authorized user of this credit and that I will not dispute the payment with my credit card company unless services are not rendered. I acknowledge that claims for delays or damaged/missing items does remove or offset my obligation to pay for services, and that should the need for a claim arise, I will abide by the Terms & Conditions set forth and agreed to herein.
Agreement
I, THE UNDERSIGNED, HAVE READ THIS AGREEMENT CAREFULLY, WHICH INCLUDES THE TERMS & CONDITIONS AGREED TO PREVIOUSLY OR SUBSEQUENTLY. I AUTHORIZE SHLEPPERS MOVING & STORAGE TO MOVE, PACK, SHIP, STORE, AND/OR PERFORM THE SERVICES HEREIN. I ALSO CONFIRM THAT IN ACCORDANCE WITH THE CALIFORNIA PUBLIC UTILITIES COMMISSION, I HAVE RECEIVED FROM SHLEPPERS MOVING & STORAGE A COPY OF THE INFORMATIONAL MATERIAL ENTITLED “ IMPORTANT INFORMATION FOR PERSONS MOVING HOUSEHOLD GOODS (WITHIN CALIFORNIA).
CUSTOMER NAME:     

Leave this empty:

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Signature Certificate
Document name: Job Starting Form
lock iconUnique Document ID: b0d2ea847a8f1224357da9271313cc1445545070
Timestamp Audit
November 30, 2021 3:43 am PDTJob Starting Form Uploaded by Shleppers Moving & Storage - info@shleppers-ca.com IP 45.49.139.219