Pickup Request

* REQUEST/SHIPPER/CONSIGNEE are all required fields

REQUESTED BY

Contact Name:
Company:
Contact Tel:
Contact Email:

SHIPPER INFORMATION

Contact Name:
Company:
Street Address:
City:
Contact Tel:
Contact Email:
Pickup Date:
Pickup Time:

CONSIGNEE INFORMATION

Contact Name:
Company:
Street Address:
City:
Contact Tel:
Contact Email:
Delivery Date:
Delivery Time:


SHIPMENT DETAILS   open unit converter

PCSWT (lbs)DescriptionL (in)W (in)H (in)

SPECIAL REQUIREMENTS

Private Residence Pickup
Private Residence Delivery
Temperature Control   Temp:   °C   °F
Multi Temp   Temp:   °C   °F
Hazardous Goods
Inbond
Pallets Being Returned
Premium Booking

PAYMENT TYPE

Prepaid   Collect   Third Party

Valuation of Goods:

SERVICE LEVEL

Economy (Not Specified)     General (3-4 days)     Expedited (1-2 days)

Quote Number: