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Delivery Request Form
1
Delivery Amount
*
This field is required.
How many deliveries do you need help with today?
One Delivery - One drop off location
Multiple Deliveries - Multiple drop off locations
One Delivery - One drop off location
Multiple Deliveries - Multiple drop off locations
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2
Multiple Delivery Details
*
This field is required.
Please provide us with a pick up & delivery address, contact person and phone number for each item to be delivered
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3
Your Delivery Details
Please enter your delivery details, wait for the distance to automatically calculate and click "next"
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4
Delivery Distance
Please be aware that we have a minimum delivery distance of 4km.
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5
Delivery Price
Your delivery price includes GST
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6
Delivery Options
*
This field is required.
Please select a delivery option, based on your preferred time frame. Please note that prices vary based on delivery time frames.
Standard: Delivery by end of day
Priority: Delivery within 3 - 4 hrs of pickup
Express: Delivery within 1 - 2 hrs of pickup
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7
Delivery Price
Your $AUD delivery price includes GST
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8
Delivery Price
*
This field is required.
Your $AUD Delivery price, including GST
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9
Would you like to proceed?
*
This field is required.
Would you like to proceed with your delivery
YES
NO
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10
Your Name
*
This field is required.
First Name
Last Name
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11
Your Business
*
This field is required.
The name of your business
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12
Your Email
*
This field is required.
example@example.com
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13
Phone Number
*
This field is required.
Please provide us with your phone number
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14
Item for delivery
*
This field is required.
Please enter the item we will be delivering for you
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15
Pick up contact
*
This field is required.
Who is the person we are picking your item up from
First Name
Last Name
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16
Delivery Contact
*
This field is required.
Who is the person we are delivering your item to
First Name
Last Name
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17
Delivery Verification
*
This field is required.
Please select the type of delivery verification you required
I require my delivery to be signed for by the receipient
I don't need my delivery to be signed for
You can leave my delivery unattended
I require my delivery to be signed for by the receipient
I don't need my delivery to be signed for
You can leave my delivery unattended
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18
Payment
*
This field is required.
How would you like to pay for your delivery
Debit/Credit card at pickup/delivery
Invoice
Debit/Credit card at pickup/delivery
Invoice
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19
Special Instructions
Please let us know if you have any special requirements for your delivery
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20
Order Approval
Approve
Reject
Approve
Reject
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21
Get Page URL
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Delivery Request Form
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