LONG DISTANCE DISCLOSURE FORM

Thank you for allowing us to handle your long-distance move.

You have provided us with the following information about your delivery:

Customer Name:

Phone Number:  

Email:  

First Available Delivery Date:  

DELIVERY ADDRESS:

 

Is there a contact person(s) other than the customer?

ADDITIONAL CONTACT INFORMATION

 

Additional Delivery Information:

  • Standard rate interstate deliveries will be within 1-21 business days from the earliest date you are ready to receive your shipment.
    • 101-500 miles=6 business hours-5 business days
    • 501-1000 miles=5-10 business days
    • 1001-1500 miles=7-14 business days
    • 1501-3300 miles=7-21 business days

Is there access for an 18-wheel trailer (53-foot truck) at your residence, street, or city?

Do you have more than one flight of stairs (12 steps) at your destination?

Is the distance more than seventy-five (75) feet from the entry of your home to accessing the truck?

Customers must be available at the time of delivery to accept shipment. Any delay(s) caused by the customer will result in the following additional charges:
Each hour of waiting: $75.00/hr
Full Day Waiting: $750

Your signature confirms this information to be accurate to the best of your knowledge.

DOT#2306227 MC #787354 PUC #MTR0190959

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Signature Certificate
Document name: Long Distance Disclosure
lock iconUnique Document ID: 8e8c646b00118533a486ce81903b31831622a57a
Timestamp Audit
June 9, 2022 11:21 am PDTLong Distance Disclosure Uploaded by Shleppers Moving & Storage - info@shleppers-ca.com IP 116.74.112.206
June 9, 2022 11:23 am PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:23 am PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:28 am PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:28 am PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:39 am PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:39 am PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:48 am PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:48 am PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:52 am PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:52 am PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:54 am PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 9, 2022 11:54 am PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
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June 9, 2022 11:59 am PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
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June 13, 2022 2:49 pm PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 13, 2022 2:54 pm PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 13, 2022 2:54 pm PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 13, 2022 2:58 pm PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 13, 2022 2:58 pm PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
June 24, 2022 12:33 am PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 116.74.112.206
June 24, 2022 12:33 am PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 116.74.112.206
June 24, 2022 12:33 am PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 116.74.112.206
June 24, 2022 12:33 am PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 116.74.112.206
July 5, 2022 10:48 pm PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 116.74.112.206
July 5, 2022 10:48 pm PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 116.74.112.206
July 5, 2022 10:53 pm PDTDispatch Department - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 116.74.112.206
July 5, 2022 10:53 pm PDTJob Documents - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 116.74.112.206