Qualification Questionnaire

Pre-Qualification Questionnaire
Name*

First NameLast Name
Phone Number
Please enter a valid phone number.
IF NO PHONE NUMBER OR EMAIL ADDRESS PLEASE GIVE ANY METHOD OF CONTACT. PLEASE GIVE DETAILS ON METHOD OF CONTACT ( IF NEED TO LEAVE A MESSAGE OR SEND A TEXT OR IF IT IS A FRIEND, FAMILY ECT...)
Email
Please enter a valid email address.
Current Job (company and position) if applicable
Example: Target/Cashier or Cashier at Target
Are you enrolled in any government assistance programs?
MONTHLY INCOME
PLACE YOU WANT ITEMS LEFT UPON DELIVERY
ADDRESS/ ***IF YOU DO NOT HAVE AN ADDRESS PLEASE GIVE MAIN CROSS STREETS AND DIRECTIONS TO WHERE YOU STAY AS WELL AS A WAY FOR OUR DELIVERY DRIVER TO CONTACT 24HRS PRIOR TO DELIVERY
*** SUBMITTING THIS FORM MEANS YOU AGREE TO ITEMS BEING DELIVERED BETWEEN THE HOURS OF 8PM TO 5AM. if you have a gate code please let our cooridinator know. we will contact you 24hrs prior to delivery.
Should be Empty:

Pre-Qualification Questionnaire