Home Delivery - Inside and Uncrate

                  This form must be completed, signed and returned to The 
                Appliance Source before in home delivery can be scheduled.

         Is this new construction?           Renovation?                        
         Is this job site paved?         Dirt?         other?                   
         Are there paved walkways leading to the entrance?                      
         Is there access via steps to the entryway? If no, please explain?      
                                                                                
         How many steps are there before entry to the house, including landings?
                                                                                
         Are there any steps inside the house? If so, how many?                 
                                                                                
         Is there any special material on the steps? If so, what?               
                                                                                
         What type of material will be on the floor at the time of the appliance 
         delivery?                                                              
         What floor are the appliances going to?                  How many steps 
         and where is the access?                                               
         Are there any restricted widths or heights of any doorways, stairwells 
         or ceilings? What are the measurements?                                
         If an apartment building/highrise, is the a freight elevator? If so, is 
         there an appointment needed for it use                                 
         What is the height/width of the elevator and entrance?                 
         Are there any existing units that need to be removed? What?            

                     IF THE DELIVERY CONDITIONS ARE DIFFERENT FROM 
                     THOSE STATED ABOVE, ADDITIONAL CHARGES MAY BE 
                    INCURRED AND WILL BE DUE AT THE TIME OF DELIVERY.

         Job Site Name:                   Invoice/Sales Order#:                 
         Job Site Address:                                                      
         Contact Ph. numbers:                     Home:                         
         Cell/Alt.                                                              

         Customer Signature:                         Date: