If new customer, please fill out credit application. * = Required InformationCustomer Name* Contact Name* Address Freight Pick Up Address (If other than Basic Enterprise) Address(Cont.) City State Zip Phone*Fax Email Pick up at Basic Enterprise 2567 Greenleaf Ave Elk Grove Village, IL 60007 Bill to AddressIf different than customer listed above Pieces/Weight If not known, estimated Pieces & WeightDim Weight Ready Time : Hours Minutes AM PM AM/PM Close Time : Hours Minutes AM PM AM/PM Destination City Hazardous Paperwork Pickup @ Customer Address Basic Enterprise Other Additional requirements / Delivery Information Lift Gate 2-Man Del Residence Inside Person Completing Form