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minigari

Serving South Florida for Over a Decade

Dade: (305) 759-5002
Fax: (305) 759-6103
Toll Free: (800) 276-5144

This form can be used when you do not have an established account.
NOTE: This form should not be used after hours. Please call direct at the phone numbers listed above.

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Shipment Information
Description of Shipment*
Shipment Details*
Shipment Weight*

Pick-up Location
Company Name*
Company Address*
Street Address Line 1 Street Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name*
Contact Phone Number*
Pick-up Instructions*
Job Reference*
Date of Pick-up*
MM slash DD slash YYYY
Round Trip?
- Yes
- No
Time*

: HH

MM

AM/PM

Destination Information
Company Name*
Company Address*
Street Address Line 1 Street Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name*
Contact Phone Number*
Destination Instructions*

Payment Information

Note: If you do not wish to send credit card information over the internet, you can leave this part blank, go back to the Online Services page after submitting this form, and click on "Credit Card Authorization". You can then print the authorization form, fill it and fax it to us for immediate processing of your order.
Billng Name*
First Last
Billing Address*
Street Address Line 1 Street Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Fax Number*
Email*
Credit Card Type*
Credit Card Number*
Expiration Date*
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Comments
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Serving South Florida for Over a Decade

Shipment Information

Pick-up Location

Destination Information

Payment Information

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