Delivery Form

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.
Store or pick up location business name.
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
Items to be delivered

Sofa Reclining Sofa Loveseat Reclining Loveseat Sectional Reclining Sectional Bookcase Mattress 3p Dining Table 5p Dining Table Sectional Reclining Sectional Other
Is this item manufactured by Broyhill? *

Yes No
Transaction # or last 4 of order #if available T blanks
If your item is not on the list, please add here.
Date (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.

Month Day Year
Date
Please select a delivery time.
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.
We accept debit card, credit card, cash and online payments

*Customer to measure rooms, doorways, hallways, and address anything that may obstruct the path of the movers.

*Items that do not fit or do not meet your standards for any reason will incur a redelivery to the store fee.

*Neither the store nor the delivery service is responsible for merchandise that does not fit.

*Customer is responsible for payment of delivery /or returning merchandise to the retailer.

*Floor model furniture is purchased at your own risk. We do not assume, nor are we responsible for the condition prior to your delivery.
SHOULD YOU HAVE ANY QUESTIONS OR NEED ANY INFORMATION ABOUT YOUR DELIVERY, CALL OR TEXT 918 361-1694. THE STORE OR PICKUP LOCATIONS ARE NOT ABLE TO ASSIST YOU WITH DELIVERY INFORMATION.
Signature: By signing this form you agree that you have read, understand, and agree to the above terms and conditions. Payment is due on or before delivery. Delivery charges can not be paid in-store.

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