Order Form

Dispatch Direct: 1-877-766-7040

ORDER REQUEST FORM

Today's Date:

ORF Number:

Company Name: Required

Account Number:

Person Ordering: Required

Your Phone Number: Required

Your Email Address: Required We'll never share your email with anyone else.

Required
Is this a NEW job?

YES

Required
Has this job been quoted?

YES

Quote Number:

Purchase Order Number:

Job Name: Required

Job County: Required

Job Address: Required

Job City: Required

Job State: Required

Job Zipcode:

Job Site Contact Name: Required

Job Site Contact Phone: Required

Required
Requested Delivery Date:

Required
Requested Delivery Time:

When ordering Dump Truck Rentals, (Place order below) please specify an onsite start time:

Is this rental for all day?

YES

NOTICE: 6:00am-9:00am DELIVERY TIME IS A RAIN AND OR SHINE ORDER ONLY.
This time frame is accepted as a rain and or shine order only. To fulfill these orders, trucks must be in transit to various loading sites hours prior to your requested delivery time frames. If orders are changed and or canceled for any reason, the customer will be charged the full haul rate, rental rate and or minimum charges per truck based on the individual situation.

Required HOLD ORDER if inclement weather?

YES

Hold orders will be held until the customer calls the Aggtrans dispatch department to reschedule. Please keep in mind that the weather may be different in various regions. This may change your order status and the customer should call ASAP to reschedule if the weather is different in your region. We do not hold trucks for specific time frames and or jobs unless previous arrangements have been made. There are no guarantees that the original time frames can be filled due to ongoing dispatch schedule changes during these weather events.

Order Item 1.

Category:

Products/Services:

Quantity:

Units:

Order Item 2.

Category:

Products/Services:

Quantity:

Units:

Order Item 3.

Category:

Products/Services:

Quantity:

Units:

Order Item 4.

Category:

Products/Services:

Quantity:

Units:

Order Item 5.

Category:

Products/Services:

Quantity:

Units:

Notes:

Terms and Conditions:

This online order is not to be considered a confirmed order until the customer receives a reply confirmation, Monday-Friday between the hours of 7am-4pm. The customer is responsible for the accuracy of information submitted on this order form. Please double check all information before submitting your order. If you have questions about your order or this order form, please call the dispatch department for further details. Dispatch Direct: 1-877-766-7040.

I have read and understand all the terms and conditions as stated above. Required

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