PDQ Delivery Online Order Form

PDQ Account Number:

Your Name:

Phone Number:

Your e-mail address (if applicable):

Select Desired Method of Payment (Credit Card, Check, Cash):
Bill my PDQ Account Credit Card - Visa Credit Card - Master Card Credit Card - Discover Credit Card - American Express Cash - Cash will be at Pick Up Cash - Cash will be at Drop Off Check - Check will be at Pick Up Check - Check will be at Drop Off

If Paying by Check or Cash, we will call you back with your Total.
(Please make checks payable to PDQ Delivery).

If using Credit Card: Credit Card Number:

Expiration Date (00/00):

Please Select One:

Check if PDQ Account is the Pick Up Location.

Check if PDQ Account is the Drop Off Location

Third Party Billing (pick up and drop off information must be filled in).

Pick Up Information

PRE-SET PICK UP:
100 105 110 120 125 130 135 140 145 150 155 160 165 170 175 180 185 190 195 200 205 210 215 220 225 230 235 240 245 250 255 260 265 270 275 280 285 290 295 300

Pick up: Company Name:

Pick up: Address:

Pick up: Suite:

Pick up: City:

Pick up: Zip Code:

Pick up: Phone Number:

Pick up: Special Instructions:

What are We Picking Up?

Drop Off Information

PRE-SET DROP OFF:
100 105 110 120 125 130 135 140 145 150 155 160 165 170 175 180 185 190 195 200 205 210 215 220 225 230 235 240 245 250 255 260 265 270 275 280 285 290 295 300

Drop off: Company Name:

Drop off: Address:

Drop off: Suite:

Drop off: City:

Drop off: Zip Code:

Drop off: Phone Number:

Drop off: Special Instructions:

If Your Company uses a Billing Referance (Job Number),
Put it here:

Please Choose: Level of Service:

Regular.

Rush.

Super Rush.

Would you like us to call you back to confirm Your Order?

No need to confirm Order.

Yes, please confirm My Order.

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