QS Delivery Service, Inc. - Your Messenger Service

CALL NOW 847-912-0357

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FOR ALL NEW CUSTOMERS, PLEASE CALL FIRST TO OPEN ACCOUNT WITH US.

>> Pick up information
Company Name:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email:

>> Service Information
Type of Service:	4 Hours Same Day Overnight HOT RUSH
Weight:	Lbs
# of Packages:

>> CONSIGNEE Information
Company Name:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email:

>> Billing Address (if different than pick-up or consignee)
Company Name:
Address:
City:
State:
Zip Code:

>> Business Information ( ONLY New Clients ):
Ownership:	Individual Partnership Corporation
How Long in Business:
Type of Service or Product:
Person Authorizing Account:
Title:
Contact Person and Phone for Accounts Payable

>> Reference Information ( ONLY New Clients ):
Name #1:		Phone:
Name #2:		Phone:
Name #3:		Phone:

>> Miscellaneous ( ONLY New Clients ):
For use as:	Primary Carrier Secondary Backup Carrier
How did you hear about QS DELIVERY SERVICE INC?

>> Terms & Conditions
Invoices are sent approximately every two (2) weeks, are payable upon receipt and become delinquent thirty (30)) days after date. Delinquent accounts will be subject to interest at the rate of 18% per annum. If your procedures cannot adapt to this schedule, please fill in the blank below with information regarding your payment schedule. If we agree to abide by your schedule, we will consider your account overdue seven (7) days after the date(s) specified below.
Agree to terms:	Please check if you agree to terms & conditions
By submitting this form, you agree to the above terms and responsibility of payment of invoices when due.
Name:		Title: