Request a COSTARS - Road Safety Warehouse

1

Contact Information

First Name *

Last Name *

Email Address *

Phone Number *

2

Organization

Organization Type *

Organization / Municipality Name *

COSTARS Member ID (Optional)

Tax-Exempt Status *

Upload Tax-Exempt Certificate (PDF/JPG/PNG, max 10 MB)

3

Billing Details (Optional)

Bill-To Address

Accounts Payable Email

PO Number (if available)

4

Delivery Method

Pickup in Wilkes-Barre / Scranton Area (exact address provided after quote confirmation)

Select Delivery Method *

Delivery

Customer Pickup

5

Delivery Contact

On-Site Contact Name

On-Site Contact Phone

Delivery Window Preference (Optional)

6

Ship-To / Delivery Address

Street Address *

City *

State *

ZIP Code *

Is this a municipal/government facility? *

Yes

No

Government Facility Details

Receiving Hours (Optional)

Security/Check-in Required? (Optional)

Yes

No

Notes for Gate/Access (Optional)

Non-Government Location Details

Purchasing on behalf of a COSTARS member? *

Yes

No

Important: Bill-To must be the COSTARS member; Ship-To may be the contractor/job site.

Member Name *

Member ID (Optional)

Upload PO/Authorization *

Location Type

7

Products & Quantities

Product Line 1

Product *

Quantity *

Notes (Optional)

8

Delivery Services (Unloading)

Unloading Method *

Forklift available on site

Liftgate required (fee applies)

I approve adding the carrier's liftgate fee to the quote.

Appointment Required by Facility?

Yes

No

Site Restrictions (Optional)

Limited Access / Gated

No Dock

No Pallet Jack

Note: Inside/threshold delivery is not offered. Deliveries are curbside only.

9

Timing

Required-by Date (Optional)

Rush / Deadline Notes (Optional)

10

Additional Documents (Optional)

Upload PO or Bid Documents You can upload multiple files (PDF, DOC, DOCX, JPG, PNG, XLS, XLSX)

11

Additional Notes

Project / Quote Notes