PAR Order Entry Form

PAR Services
Nationwide Third Party Services

Select tabs above by clicking on the tab names (or by pressing Alt and the tab number).
See a summary of your order, and submit it, on Tab 6.

Phone: 800-662-3449
Fax: 919-662-8598

A Shining Star of Excellence in Nationwide Third Party Services

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Note: Fields with a blue background are required.

Your Information

Person Authorizing Service	Ext.	Your Local Phone	(111-222-3333)
Agent/Van Line to Invoice
Your e-mail Address		Regist. / P.O. #
		Account

Order Information

QUOTE ONLY	C.O.D.	Shipment Weight	lbs.
To update existing orders, enter their numbers →		Origin	Destination
Shipper		Shipper's e-mail Address
Origin Address		Destination Address
City State Zip		City State Zip

Phone Type (111-222-3333) EXT
Phone Type (111-222-3333) EXT
Phone Type (111-222-3333) EXT

Service Dates

	Start Date	End Date
Pack Date		(mm/dd/yy)
Load Date
Delivery Date

Perform Service At Origin Only
Destination Only
Origin AND Destination

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Washer		Origin	Dest.	Qty.	Type	Locking Kit Auth
Dryer		Origin	Dest.	Qty.	Type
Ice Maker		Origin	Dest.	Qty.	Waterline Auth
Grandfather Clock		Origin	Dest.	Qty.	Crate/Uncrate Clock
Pool Table		Origin	Dest.	Qty.	Crate/Uncrate Slate
Waterbed		Origin	Dest.	Qty.	Drain/Fill Disassemble/Assemble
Swing Set		Origin	Dest.	Qty.	Type
Chandelier		Origin	Dest.	Qty.	Put up Replacement	Ceiling Height
Ceiling Fan		Origin	Dest.	Qty.	Put up Replacement	Ceiling Height
Wall Unit		Origin	Dest.	Qty.
Exercise Equip.		Origin	Dest.	Qty.
Home Ent. Center		Origin	Dest.	Qty.
Piano		Origin	Dest.	Qty.	Lock/Unlock Keyboard	Remove & Install Legs
Plasma/LCD TV		Origin	Dest.	Qty.	Disconnect/Remove TV	Connect/Install TV	Mount
Plasma/LCD TV	(continued from line above)				Screen Size	Crate/Uncrate TV
		Origin	Dest.	Qty.	On left: blanks for special needs
		Origin	Dest.	Qty.	If more, use Tab 5 (Special Instructions).

Maid Service Cleaning Unpacking Hours authorized (minimum 8)	Debris Pick up debris
Debris Pick-up Approximate number of boxes

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	Item Description Size:	L	W	H	Solid*		Item Description Size:	L	W	H	Solid*
1						17
2						18
3						19
4						20
5						21
6						22
7						23
8						24
9						25
10						Please indicate if these are authorized. International Crating Is assembly/set-up requested? System of Measurement U.S. Metric * Indicates that solid crating is needed.
11
12
13
14
15
16

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(Optional) Enter any comments or special instructions.

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(To print, press CTRL+P on your keyboard.)

Thank you for your order.

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