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Collectable Truck


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1980 - 2005
 

*Please Fill Out All The Information
All fields with an "*" are required

Your Information:
E-mail: *
Name:  *
City: *
State:  *     Zip Code:  *
Telephone-Daytime: *

Vehicle Information:
Vehicle 1 information:

Year *Make * Model* 
Does the vehicle run?: *

PLEASE NOTE: THERE WILL BE AN ADDITIONAL CHARGE
                        FOR VEHICLES THAT DO NOT RUN.


Optional: Can leave blank if there is only one vehicle to transport.

Vehicle 2 information:

  Year  Make    Model 
Does the vehicle run? :

PLEASE NOTE: THERE WILL BE AN ADDITIONAL CHARGE
                        FOR VEHICLES THAT DO NOT RUN.


Vehicle 3 information:

  Year  Make    Model 
Does the vehicle run? :

PLEASE NOTE: THERE WILL BE AN ADDITIONAL CHARGE
                        FOR VEHICLES THAT DO NOT RUN.

Pick Up Information (Origin):
Business/Contact Name: *
Street Address: *
City: *
State: *
Zip Code: *
Primary Phone number: *
Primary Phone Location:   
Alt. Phone number:   
Alt. Phone Location:   


Delivery Information (Destination):
Business/Contact Name: *
Street Address: *
City:*
State:*
Zip Code: *
Primary Phone number: *
Primary Phone Location:   
Alt. Phone number:   
Alt. Phone Location:   


Enter your comments in the space provided below:

How did you hear about us:



Price quoted:
Note: Do not enter the $ sign		 *
      If shipping more than one car please insert the TOTAL cost for all cars.
Fuel Surcharge quoted:  
Note: Do not enter the $ sign
      If you leave the above field blank, the current fuel surcharge will be added automatically.
Date When Vehicle Available For Pickup:

*

Method of payment:

*
Payment at: *

PLEASE NOTE:
If you elect to pay by credit card - before your order can be processed we require you to sign an authorization form and fax it to us. It is available as either an Adobe Acrobat or Microsoft Word document. When you press the "Book It" button you will be taken to the order confirmation page where you can obtain the required form.

Do you want to get informed on any future promotions/specials?


Note: If you have any questions, please contact Jim Bergeron at (800) 221-3936 x106



 



Intercity Lines, Inc.
552 Old West Brookfield Rd | Warren, MA  01083
Phone: 1-800-221-3936 | Fax:1-413-436-9422
E-Mail: info@intercitylines.com

Copyright © 1997 - 2008  Intercity Lines, Inc.

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