PLEASE FILL IN THE FOLLOWING INFORMATION TO HELP US STREAMLINE YOUR REQUEST.

THE FOLLOWING FORM IS MOBILE-FRIENDLY BUT IF YOU PREFER TO COMPLETE THE FORM ON A COMPUTER, EMAIL THIS LINK TO YOUR EMAIL ADDRESS TO ACCESS IT FROM A COMPUTER: https://ramseylegacymoving.com/non-retail-picku…livery-agreement/

THANK YOU FOR CHOOSING RAMSEY LEGACY MOVING!

Client's Information

Name (First and Last) *

Delivery Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Delivery Information

Delivery Service To Be Performed *Driveway Delivery (Cheapest Option) - We Will Unload Your Order In Your DrivewayGround Floor Delivery (Standard Option)Room Of Choice Delivery (Standard Option) - We Will Deliver Your Order To The Room Of Your Choice Discussed During QuoteWhite Glove Delivery (Full-Service Option) Billed In Addition To Delivery Cost At $135/hour (Min $25) + Disposal Fee For Trash

Quoted Price or Hourly Rate Of Delivery *

Delivery Date *

Please use current date if not known

Please INITIAL That You Understand Any Additional Moving, Disassembly, Assembly At The Residence Not Agreed Upon At The Time Of Estimate/Agreement Will Be Charged $135/hour (Min $25) *

Pickup Address *Ramsey Legacy StorageGary BarnhardtOther

Pickup Address #1

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Do You Have Additional Pickup Locations? *NoYes - One More In AdditionYes - Two More In AdditionYes - I Will Listed All The Additional Location And Items To Be Picked Up

Pickup Address #2

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Pickup Address #3

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Multiple Pickup Location - Please List The Address And What Will Be Picked Up At Each Location

Condition Of Item(s) Being Picked Up? *AS-IS (Item(s) Sold AS-IS)Boxed Item(s) (Item(s) Contained In A Sealed Box)Damaged (Item Discounted Due To Severe Damage)

Items To Be Delivered (Please Include Every Piece In the Set Ex. Headboard/Footboard/Side Rails/Hardware/Etc). Please Note Adding Additional Items Not Agreed Upon, Failure To Completely Inform Us Of The Severity Of Items Will Increase Delivery Rates And May Not Be Picked Up If Time Will Not Allow In The Schedule. *

Additional Information/Services

Any Additional Information (Gate Code, Driveway Instructions)

Special Requests? MUST BE DISCUSSED WITH ADMIN STAFF PRIOR

• Workers To Wear Boot Covers During Delivery ($10 for x2 Pairs In Addition To Delivery Charges. Additional Pairs Will Be Billed $5/Pair)
• Workers To Wear Supplied Boot Covers During Delivery (Client Supplied)
• Stretch Wrap Items ($135/hour plus materials)
• Unwrap Furniture/Throw Away Trash ($135/hour + trash fee)
• Assemble Bed(s) ($135/hour min $25)
• Assemble Item(s) ($135/hour min $25)
• Move Additional Item(s) At Residence ($135/hour min $25)
• Haul Away Older Item(s) (Charged By Item)

Method Of Payment (WE DO NOT ACCEPT CHECKS) *Cash On Delivery Credit/Debt Card (3% Conv Fee In Addition)Venmo (3% Conv Fee In Addition)Paypal (3% Conv Fee In Addition)Invoice Request (4% Conv Fee In Addition)

Legal Information

Valuation On Order (compensation in the event of damages)? A basic value protection is provided at NO additional cost but only provides minimal protection that is considerably less than the average value of households goods ($0.60/lb per article). Full value protection protects for if items are lost (the mover will have the options of replacing them with articles of like kind and quality or paying the replacement cost as determined by current market value) and if items are damaged (the mover will have the same options, plus the additional options of repairing the items or paying the repair cost) Full Value Protection is an additional fee. For Full Value Protection you will need to provide receipts for items covered. Questions about valuation: https://ramseylegacymoving.com/valuation/ *Basic Value Protection ($0.60/lb) - Free CoverageFull Value Protection (Billed In Addition - $0.75 per $100 In Value)

Please note Full Value Protection has to be established before items are picked up. It's the customers responsibly to pay for this in advance before the order is picked up.

Customer Understands They Will Be Charged In Addition To The Quoted Price $0.75 per $100 In Value + $64/hour To Inventory Items Upon Pickup.Yes - I understand and agree to the additional chargeIll Select Basic Valuation Instead (Above)

Value To Be Established On Delivery

Client's Responsibilities

Client Has Measured (Door Frames/Staircases/Furniture) To Make Sure Everything Will Fit And Has Decided Where Everything Will Be Placed In Home Prior To Delivery? Please Note We Will Adjust The Piece Once After Initial Placement For Free. If items can't be delivered to area safely discussed during quote, I will decide on an alternate location at time of delivery. Adding additional steps/floors not agreed upon during quoting may increase the delivery rate at the time of delivery. *Yes - I have measured and understand if item(s) can't be delivered safely to the area discussed during the quote I will decide on an alternate location at time of delivery.

My driveway/street will accommodate a 16' box truck (overall length of 28-30' ft) with a height clearance of 12'. The grade of my driveway does not exceed a 15-degree slope. I understand failure to completely inform us of driveway conditions may result in damages to the driveway/property or an increase in the delivery rate for the extended carry of items up/down my driveway. *Yes - I understand and assume all risk/damages/additional charges by not fully informing delivery and administration staff at Ramsey Legacy of my driveway conditions.

Please Print Your First, MI, Last Name. I agree to sign this contract digitally on the following line and I have read, fully understand and agree to the terms and conditions of my delivery found here: https://docs.google.com/document/d/e/2PACX-1vQzl_1NUHPMLH5gxCX9N4g4I3k9IF-SZIyi6H5Eh7IkiNiJyeL4szXI8as9RXkWMD2O8569VJ--U5Fx/pub *

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