Kent 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 NeededHard HatBack BraceFlagging Paddle
BootsSafety GlassesHearing Protection
GlovesSafety VestOtherIf otherHow Did You Hear About FlexxStaff?MailerNewspaperYellow Pages
Word of MouthSales CallAdvertising

New Customer Information

only required for first time orders

Customer NameCodeBilling AddressPhoneFax*Federal Tax ID