SHIPPING ORDER FORM

ORIGIN INFORMATION	DESTINATION INFORMATION
Contact Name:	Contact Name:
Contact Phone#	Contact Phone#
Contact cell #	Contact cell#
Email:	Email:
Street:	Street:
City:	City:
Zip:	Zip:

VEHICLE INFORMATION

YEAR

MAKE

MODEL

PLATE

COLOR

RUNS: yes /no

Payment Type: Mark one: cash _ check _ money order _ credit card_

Amount Quoted - Deposit Amount Balance Due on Delivery

$___________ $_______ $_________________

I agree and understand all Terms and Conditions as stated by Empire Auto Transportation Group regarding the transport of my vehicle(s). By submitting this completed form, I agree to pay the above quoted amount to have my vehicle(s) transported. If payment method by credit card, I agree to have the deposit or full amount deducted from my credit card information provided by me (shipper).

And Name on Credit Card Statement will appear As “European Specialties”.

Unless payment in full is checked above, I understand that any remaining C.O.D charged or fees will be paid upon delivery of the vehicle, and that only cash or cashier’s checks are accepted. Cashier’s checks must be made payable directly to your transport carrier.

Please sighn date and mail or fax to: 315.426.9134

_______________________________________

EMPIRE AUTO TRANSPORTATION GROUP

1020 HIAWATHA BLVD

SYRACUSE, NY 13204

TEL: 315. 426.9132 FAX 315. 426. 9134