Delivery Form
Date
-
Month
-
Day
Year
Date
Name
First Name
Last Name
Email
example@example.com
Your Address
Street Address
Apartment or Suite#
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Name of store where purchase was made.
Also include street reference. For example 71st and Memorial
Pick up Address
Street Address
Apartment or Suite#
City
State / Province
Postal / Zip Code
Stairs or Elevator
Please Select
Yes
No
Items to be delivered
Sofa
Reclining Sofa
Loveseat
Reclining Loveseat
Sectional
Reclining Sectional
Bookcase
Mattress
3p Dining Table
5p Dining Table
Sectional
Reclining Sectional
Is your item Broyhill?
Other
Transaction # if available T
blanks
If your item is not on the list, please add here.
Please select a date and time after today. All time selections are within a 4 hour window of the time selected. Delivery time is an approximation. Due to unforeseen circumstances your delivery time may be adjusted. For Example 9:00am is between 9a-1p. Once this form is submitted, you will be contacted to confirm delivery date and time.
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