Receiving Request

Please complete the form below to submit a receiving request.

CUSTOMER / DESIGNER INFORMATION

Account Name

Phone

Contact Name

ORDER / CARRIER INFORMATION

Vendor / Supplier

Estimated Receiving Date

Showroom

Purchase Order Number

Carrier

Vendor / Supplier Phone Number

Bill of Lading or Freight Bill Num

ITEM INFORMATION

Please complete one line per item

Quantity

Item(s)

Client Sidemark

PO Box Num

Item Value (USD)

Type of Value Protection

Limited Liability ProtectionDeclared Value Protection

Limited Liability Protection: Reimbursement at a rate of $0.60 per pound per article with a maximum liability of $10,000.
Declared Value Protection: Repair/replacement value protection with no deductible.
Please reference our rate sheet or contact our office for further information.

Total Value for Limited Liability Protection

Total Value for Declared Value Protection