North Carolina Billing, Shipment & Pickup Request Form

6204 Corporate Park Drive

Browns Summit, NC 27214

Main: (336)931-0800

Fax: (336)931-0711

nc-transportation@hfgroup.com
Billing, Shipment & Pickup Request Form
This form must be completed and on file before your work will be processed.
PURCHASE ORDER NUMBER (REQUIRED) *
Date *

Month Day Year
Date
SCHOOL NAME *
SHIP TO ADDRESS *

Street Address

Street Address Line 2

City State

Zip Code
CONTACT NAME *
CONTACT EMAIL *
example@example.com
CONTACT NUMBER *
EXTENSION (optional)
BILL TO SCHOOL NAME *
BILL TO ADDRESS *

Street Address

Street Address Line 2

City State

Zip Code
BILL TO NAME *
BILL TO EMAIL *
example@example.com
BILL TO CONTACT NUMBER
EXTENSION (optional)
ALTERNATE CONTACT NAME *
Person who can be reached during the summer
ALTERNATE CONTACT EMAIL *
example@example.com
ALTERNATE CONTACT NUMBER
EXTENSION (optional)
LAST DAY OF SCHOOL *

Month Day Year
Date
FIRST DAY OF SCHOOL *

Month Day Year
Date
Required Authorization
AUTHORIZED PERSON NAME *
Person who can be reached during the summer
AUTHORIZED PERSON TITLE *
DATE *

Month Day Year
TRUCK SERVICE PICKUP REQUEST: Fill out only if you qualify for pickup service.

A minimum of 100 books is required for pickup
NUMBER OF TEXTBOOKS (PIECES) *
NUMBER OF LIBRARY BOOKS (PIECES) *
LOCATION OF BOOKS (door #, room name, area, etc.) *
CENTRALIZED PICKUP/DELIVERY LOCATION *

YES NO
CENTRALIZED PICKUP/DELIVERY ADDRESS *

Street Address

Street Address Line 2

City State

Zip Code
For Distribution Use Only
ACCOUNT NUMBER
PICKUP DATE
DELIVERY DATE
# OF BOXES PICKED UP
ROUTE NUMBER
# OF BOXES DELIVERED
ROUTE NUMBER
PICKUP SIGNATURE
DELIVERY SIGNATURE
Should be Empty: