white glove intake form

White Glove Intake Form

Please fill out all of the necessary fields below in order for us to make your white glove delivery and install as smooth as possible. Thank you

Order Number *

Date *

Customer Information

First name

Last name *

Company

Full address *

Apartment, suite, etc. (optional)

City *

Country *

Province/State/Region *

Postal code *

Delivery Phone Number *

Product Sku (Part Number) *

Delivery and Set-up Instructions

Is this a house, apartment or facility? *

What floor of the residence will the setup be on? *

Are there any obstacles leading up to the delivery address? *

Are there any outside stairs? If yes, how many roughly *

Where in the home/facility is this being set up? *

Is this a 1 or 2 Technician job? *

What is the best week day/time for deliveries? *

Is there anything else the technician needs to be aware of? *

Senior.com Rep Who Helped You

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Order Total (The sum of all the prices of all the items in the order, taxes and discounts included.)

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Contact information

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Shipping address

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Billing address

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