Delivery-Reservation Form

Dear customer, Eilat Delivery thank you for your decision to use our services, If you want to make a reservation you have to fill out the form and submit.

Customer Details

Full name:      Business name: 

Email :           Fax :                 

Phone :           Cellphone :         

Country :        City :                       

Address to send bill :     

Sender Details

Full Name:      Business Name: 

Phone :            Cellphone :       

Address  :       city: other city

Delivery Type:   Amount:

Pick up Date: Day    Month   Year

Hour Rang:  between  Hour + to  Hour +

Recipient Details

Full Name:      Business Name: 

Phone :            Cellphone :          

Address  :       city: other city

Price : 

waiting time :100 shekels  for each hour the charge  will be by minutes the customer will inform immediately,

Additional Instructions: