Container Delivery Request Form

Business Name
Contact Name First Last
Physical Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Contact Phone * - (###) - ### ####
Contact Fax - (###) - ### ####
Email Address *
Ship-to Address same as Physical Address? * Yes No
If Ship-to Address is same as Physical Address leave Ship-to Address fields below blank
Ship-to Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Billing Address same as Physical Address? * Yes No
If Billing Address is same as Physical Address leave Billing Address fields below blank
Billing
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Container Size: *

Container Size: length: width: depth: weight limit*: 10 12 ft. 8 ft. 3.5ft 2 tons 20 22 ft. 8 ft. 3.5 ft. 3 tons 30 22 ft. 8 ft. 3.5 ft. 5 tons 40 22 ft. 8 ft. 6.5 ft. 7 tons * Tonnage limits may vary, call for details
Material: *

Material: Select what you will be putting in your container. If “Other” is selected, please describe material. See disclaimer at the bottom of this form for material we cannot accept. Call for details.
If other selected above describe material:
Action * Initial Drop off Exchange Pick-Up
Preferred Delivery Date / MM / DD YYYY
Special Instructions

Special Instructions: Use this space to write any detailed instructions for service. For example- where to place container or preferred time of service.
Grinnell may require 24 to 36 hours advance notice to schedule product service. All product deliveries are C.O.D. unless prior credit is established. (Credit App can be found online here) Past due accounts are subject to collection fees if necessary. Customer acknowledges delivery is customarily at curbside and agrees that if he or she requests delivery of product other than curbside that Grinnell, its agents and employees shall not be liable for any loss of person(s) or property. Customer assumes the risk of loss as to such delivery knowing that Grinnell relies on this agreement in accommodating and complying with customer’s request.

Load Container Water Level. Do not move container with machines. No Paint Cans. Additional fees will be charged for miscellaneous items such as tires and mattresses.

We accept Master Card, Visa, American Express, Discover & Check.