[swiftsign swift_form_id=”999″] I, (Enter First and Last Name)[swift_name size=”medium”], agree to the terms noted on the order for service emailed to me:
PLEASE ENTER THE JOB ID ON YOUR ORDER FOR SERVICE. THE JOB ID CAN BE FOUND ON THE UPPER LEFT OF OFS.
[swift_textbox name=”ID” placeholder=”JOB ID” required]
WHICH VALUATION OPTION DO YOU PREFER NVP, RVP, OR FVP? PLEASE TYPE IN BELOW.
Reminder: NVP (No Coverage) RVP (Some Coverage) FVP (Full Coverage)
[swift_textbox name=”valuation” placeholder=”Valuation” required]
PLEASE SELECT YOUR LEVEL OF WAREHOUSE INSURANCE
$18/month for $10,000 of warehouse insurance
$36/month for $20,000 of warehouse insurance
$54/month for $30,000 of warehouse insurance
$72/month for $40,000 of warehouse insurance
$90/month for $50,000 of warehouse insurance
$108/month for $60,000 of warehouse insurance
$126/month for $70,000 of warehouse insurance
$144/month for $80,000 of warehouse insurance
$162/month for $90,000 of warehouse insurance
$180/month for $100,000 of warehouse insurance
Waive Warehouse Insurance
Enter the amount of valuation below. Example: $10,000. If you waive warehouse insurance simply type “Waive”.
[swift_textbox name=”insurance” placeholder=”Warehouse Insurance required]
I have read the OFS (Order for Service) emailed to me and agree to its provisions and acknowledge receipt of its copy and wish this carrier (Liberty Bell Moving & Storage) to perform all the services required.
CLICK THE PEN SYMBOL TO SIGN FROM YOUR MOUSE OR IF A MOBILE PHONE; WITH YOUR FINGER. CLICK THE KEYBOARD SYMBOL TO TYPE YOUR SIGNATURE.
Signed and agreed on this [swift_date_long].
Primary Email: [swift_email value=”email@example.com” readonly]