LOAD MOVE ORDER

Office: (406)-259-1528
Fax: (406)-254-2759

Brad Cell: (406)-855-3625 Corinne Cell: (406)-696-3645

Kim Cell: (406)-855-5929 Charity Cell: (406)-697-3490

After Hours Dispatch: (406)-860-4202

ORDER DATE:__________

Bill To:________________________________________ Address:_________________________________

City:__________________________State:_______ Zip:________ PHONE#:__________________________

BUYERS NAME:___________________________________________ PHONE#:__________________________

UNITS TO MOVE:

Year Make Model Color Description Vin # [Last 8] Arb.

1. Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN:___________________Y/N___
2. Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

3. Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

4. Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

5. Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

6. Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

7. Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

8. Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

9. Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

10.Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ___________________ VIN: ___________________Y/N___

11.Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

12.Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

13.Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

14.Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

15.Yr ___ Make: __________ Model: _______________ Clr: ________ Desc: ____________________ VIN: ___________________Y/N___

>>DELIVER TO>>
_______________________________________
Address: _______________________________
City:___________________State_____Zip_____
Phone #: _______________________________
Contact: _______________________________

>>PICK UP LOCATION>>
_______________________________________
Address: _______________________________
City:___________________State_____Zip_____
Phone #: _______________________________
Contact: _______________________________

UNIT RATE: _____________________LOAD RATE:___________________ ETA: ________________________

A signed original Bill of Lading is required for payment. A $50.00 non-compliance fee will be deducted from your payment if BOL is not received within 48 Hours of delivery. Any freight damage must be reported within 48 hours. Any unreported or late damage claims will result in forfeiture of payment to carrier and carrier will be liable for all freight damage costs.
NOTE: Pick-up and delivery dates are not a contractual obligation; they are given as a best estimate only. All existing damage MUST be signed for by receiving party. J&S Transportation is NOT responsible for damage or loss to after market or third party accessories.

THIS BROKERAGE AGREEMENT MUST BE SIGNED AND FAXED BACK BEFORE ANY TRANSPORTATION TAKES PLACE. Insurance Certification must be on file with J & S Transportation. Carrier agrees to the price listed above.

X___________________________________________________________________ e-mail: info@jandstransport.com

(Signature, Company Name, Title and Date)