Intake form

Name *

Email address *

What service are you interested in?

Please select at least one option.

Delivery Service

Live Streaming Platform

What type of delivery do you require?

What is the delivery address?

What items do you need delivered?

What date do you need the delivery?

What time do you prefer for delivery? How much does your order cost?

How did you hear about us?

Please select at least one option.

Social Media

Friend or Family

Online Search

What platform do you intend to use for live streaming?

Do you require assistance with setting up the live streaming?

Additional questions or comments

What is your phone number?

How many items do you need delivered?

What is the weight of the items you need delivered?

What type of items do you need delivered?

Please select at least one option.

Groceries

Furniture

Electronics

Clothing

What is your preferred payment method?

What is your preferred method of communication?

Please select at least one option.

Email

Phone

Text Message

What type of event are you live streaming for?

What is the expected duration of the live stream?

How much does your order cost?

Price

Instantly Inc.