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Burlington Job Order Sheet

*Note: All fields marked with an asterisk (*) are required.
*Order Requested By*Number of Workers Needed*Job Date

 Order Information

*Company name*Job Site Address*Report To*Time*Job Site PhoneMobile*Job DescriptionPO Number*Special QualificationsEmployee RequestedDirections to SiteCross StreetsSafety Equipment Needed

If otherHow Did You Hear About FlexxStaff?

New Customer Information

only required for first time orders

Customer NameCodeBilling AddressPhoneFax*Federal Tax ID