Delivery Request Form
Contact 613 617 9671 or orders@veloz.ca for assistance
Order ID
Client
Pickup Address
Delivery Address
*
Please include postal code, suite no, and buzzer code if needed.
Additional instructions
Ex: Large box, leave by porch, don't knock etc.
Delivery Contact name
*
First Name
Last Name
Delivery Contact Phone#
*
Please enter a valid phone number.
Delivery Contact Email
*
example@example.com
Delivery Date
*
-
Month
-
Day
Year
Submit by 1pm for sameday service.
Hidden Current TIme
Hour Minutes
AM
PM
AM/PM Option
Hidden Current Date
-
Month
-
Day
Year
Date
Member
*
Please Select
Jason
Paul
Johnny
Mo
POD
*
Status
Please Select
Completed
Cancelled
Pending
Take Photo
Total
hst not included
Submit
Should be Empty: