Independent Delivery Contract Instructions: Please enter your information. Answer all questions. Penny's by Plaza Flowers 610-513-2501

Personal Information

Name *

Prefix

First *

Last *

Suffix

Address *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Cell Phone Number *

### - ### - ####

Email Address

Driver License Number / State

INSURANCE/AVAILABILITY:

Auto Insurance Company *

Policy Number / Expiration Date

Days Available *

Monday   Tuesday   Wednesday   Thursday   Friday   Saturday   Sunday   Any

Hours Available *

AM   PM   Any

Streets I know best are in these counties (check all that apply) *

Philadelphia   Bucks County   Montgomery County   Chester County   Delaware County   Anywhere

Which of the following best describes your delivery vehicle. *

Sedan   Hatchback   SUV   Minivan   Panel van   Other   In the box below, please tell us if you have access for a GPS device. List the manufacturer. Also, Please use the box for any other pertinent information.

What date are you available to start delivering? *

MM / DD / YYYY

This contract is an agreement between an independent contract delivery person (Driver) and Penny's by Plaza Flowers (Plaza). Driver accepts the following requirements as the minimum acceptable conditions of agreement:

Driver posesses a valid driver's license.   Driver provides a fully insured vehicle with valid registration and inspection.   Driver accepts full liability for personal injury.   Driver accepts full liability for damage to vehicle or other property.   Driver accepts full responsibility for traffic violations and parking tickets.   Driver will match package order number upon arrival.   Driver agrees to deliver all products in the condition as they left the shop.   Driver agrees to allow NO SMOKING IN THE VEHICLE.   Driver agrees to promptly update delivery status at edelivery.eflorist.com

Plaza and Driver accept the following conditions of compensation:

(1) 5 business days after completion of deliveries, Plaza will pay Driver for each and every delivery completed in good condition to the correct address at the correct time. Each address is considered one delivery regardless of the amount of packages.

(2) The compensation is $7.00 for every delivery in 19038, 19403, 19407, 19408, & 19409; $9.00 for every delivery in the remaining zip codes.

It is hereby acknowledged that Penny's by Plaza Flowers is not liable for personal injury or vehicular damage incurred while Driver is performing duties as a contract delivery person.

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Do you agree with the terms and conditions? *

Yes, I agree.

Initial *

Date *

MM / DD / YYYY