Sales Person:
SHIPPING ORDER - BILL OF LADING                         FIRST DATE CAR AVAIL. FOR TRANSPORT:   
PICK UP CAR FROM
 
Name: Home Phone: Cell Phone: Business Phone:
Address: City/State/Zip:  
DELIVER CAR TO
Name: Home Phone: Cell Phone: Business Phone:
Address: City/State/Zip:  
CAR DESCRIPTION
 
Registered Owner or Leasee:
 Car Make/Model/Year:
 /  / 		 Lic. Plate Number/St:
 / 		 Color:
   ADDITIONAL INFORMATION AND PHONE NUMBERS FOR PICK UP OR DELIVERY:
   
 CHECK: Sedan   Full Size Stat. Wgn.   Van   Jeep   P/Up Truck   Inoper. Veh.,
  Oversize Veh.,   Luggage: Yes   No  

 Regular Price
 

 Credit Card Price
 

 Additional Services
 

 Total:
 


 
Check    Visa    MC   
Full Payment with order or
$200 deposit Balance cash or cashiers check on delivery.
Full payment by credit card. 		 

Card No.:         Exp. Date:

Card Holder:         Auth. Signature X                                                               

Price valid for 30 days.  A $50 charge will be assessed for returned checks.

How did you hear about our service?

 I have read and I agree to the conditions on the following page of this order as an integral part of this order.

 
 

Name and Date: _______________________________________

  

X ___________________________________________________
 

Owner's or Shipper's Signature

Please Print and Sign the form and fax to:  (775) 659.2837
 
or Mail To:  Peg Trucking Inc.
                   2525 Randolph Rd.  
                   Janesville, WI  53545