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?  

If there is no access for an 18-wheel trailer, I understand that a shuttle and shuttle fee will be required and charged.  

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

I understand that if there is more than one flight of stairs, a stair charge will be added.  

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

I understand that if the distance is more than 75 feet, there will be an additional charge for the long carry.  

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

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Long Distance Disclosure/DOJ/UNIVERSAL ENTRY
lock iconUnique Document ID: d166ede634e68cede4ec44b4d031698fe2b214a2
Timestamp Audit
July 29, 2022 9:28 pm PSTLong Distance Disclosure/DOJ/UNIVERSAL ENTRY Uploaded by Shleppers Moving & Storage - info@shleppers-ca.com IP 98.149.176.34
July 29, 2022 9:31 pm PSTLong Distance Disclosure - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 99.6.251.203
July 29, 2022 9:31 pm PSTLong Distance Disclosure - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 99.6.251.203
August 25, 2022 1:53 pm PSTLong Distance Disclosure - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
August 25, 2022 1:53 pm PSTLong Distance Disclosure - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 198.72.180.97
February 24, 2023 3:10 pm PSTLong Distance Disclosure - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 98.149.176.34
February 24, 2023 3:10 pm PSTLong Distance Disclosure - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 98.149.176.34
April 10, 2023 8:05 am PSTLong Distance Disclosure - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 174.204.184.11
April 10, 2023 8:05 am PSTLong Distance Disclosure - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 174.204.184.11
April 17, 2023 10:35 am PSTLong Distance Disclosure - docs@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 98.149.176.34
April 17, 2023 10:35 am PSTLong Distance Disclosure - dispatch@shleppers-ca.com added by Shleppers Moving & Storage - info@shleppers-ca.com as a CC'd Recipient Ip: 98.149.176.34