CLR Auto Transport
8350 Whitcomb Street
Suite A, B & C
Merrillville, Indiana 46410
Phone: 1-888-257-2677
1-219-795-1040
Fax: 1-219-795-1456
Email:
CLR@CLRAutoTransport.com
Corporate Shipping Order Form
To downlaod a faxable form,
Click Here
.
All fields marked with an asterik (
*
)
are required.
Part 1 - Vehicle Information and Availability
Vehicle #1
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #2
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #3
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #4
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #5
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #6
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #7
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #8
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #9
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #10
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #11
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #12
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #13
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #14
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #15
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #16
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #17
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #18
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #19
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Vehicle #20
Transportation via (select one)
*
:
Open Carrier
Enclosed Carrier
Professional Drive Away
Is the vehicle in running condition?
Yes
No
Year
*
:
Make
*
:
Model
*
:
Color:
License Plate# (if available):
Vin #
*
:
Registered Owner
*
:
Pick-up Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Delivery Information
Location Type
*
:
Residential
Business
Contact Name: First
*
:
Last
*
:
Address
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Evening Phone:
Part 2 - Customer Contract Terms and Conditions
By typing in the signature field in this section (Part 4), you acknowledge that you have fully read our "
Customer Contract Terms and Conditions
" and fully understand this agreement.
To read the "
Customer Contract Terms and Conditions
"
CLICK HERE
.
I have read and agree to the "
Customer Contract Terms and Conditions
"
*
.
Customer Signature
*
:
Date (mm/dd/yyyy)
*
:
Part 3 - Billing Information
Company name or Government agency
*
:
Department:
Note: Address Line OR P.O. Box is required below!
Address
*
:
P.O. Box
*
:
City
*
:
State
*
:
Zip
*
:
Daytime Phone
*
:
Ext:
Purchase Order Number
*
:
Additional Information/Comments:
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Copyright ©2005 CLR Auto Transport
