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:
First Available Delivery Date:
Is there a contact person(s) other than the customer?
ADDITIONAL CONTACT INFORMATION
Additional Delivery Information:
Is there access for an 18-wheel trailer (53-foot truck) at your residence, street, or city? YESNO
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? YESNO
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? YESNO
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/hrFull 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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Your legal name
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Long Distance Disclosure/DOJ/UNIVERSAL ENTRY
Agree & Sign