Delivery Request Form
Contact 613 617 9671 or orders@veloz.ca for assistance
Client
Category
Pickup Address
Delivery Address
*
Postal code required
Zone
Service
Additional information
Ex: Large box, buzzer#, delivery instructions 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
*
-
Day
-
Month
Year
Submit by 1pm for sameday delivery. Mon-Fri.
subsubtotal
Subtotal
hst not included
Submit
Admin Only
Member
Please Select
Jason
Liam
Johnny
Mo
POD
Status
*
Please Select
Completed
Cancelled
Pending
Take Photo
Price
Close Delivery
Hidden Current Time
Hour Minutes
AM
PM
AM/PM Option
Hidden Current Date
-
Day
-
Month
Year
Date
Client Form
Client Submissions
Should be Empty: