90 Minute Courier, Inc. 
  Place an Order Using a Credit Card
This form should be used, when you do not have an established  account. 
 Required fields in red 
Short Description of Shipment     Shipment Details                                   Shipment Weight
               Lbs.
                     Pickup                     Destination
Company Name
  		 Company Name
  
Company Address
 		 Company Address
 
City, State, Zip Code
  		City, State, Zip Code
 
Contact Name
 Contact Name
Pickup Contact Phone Number
  		 Destination  Contact Phone Number
  
Pickup Instructions
 Destination Instructions
Job Reference                          Round Trip
       Yes  No 		  
Date Of Pickup                    Time of Pickup 
Date Input        
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.
Billing Name:  Billing Address:
City:   State:  Zip:   Phone:
Fax:  Email Address:
Credit Card Type:    Card Number:
Expiration Date: /
Cardholder Name:
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