Loose: Are we
required to assist in loading or unloading?
Yes
No
Unitized:
Specifiy pallet/unit size
Can pallets be double stacked?
Yes
No
Approximate Individual Unit Weight
Total Units Shipped/Total
Weight Shipped
Origin City,
State, Zip
Destination
City, State, Zip
Released value (US $)
(Our Maximum Cargo Liability is $100,000)
Required Pickup Date
Required Delivery Date
Special handling or requirements we should
know about in advance
If items to be shipped cannot be released at
origin or received at delivery at one time, will you need storage?
Yes
No
If Truckload,
type of equipment required:
Closed
Van
Refrigerated
(specify temperature required,
degrees F)
Flatbed
Other
Tarp?
If the shipment is of a truckload quantity,
would you also like us to quote rail service if practical & cost effective?
Yes
No
Who is paying our charges?
Shipper
Receiver
Third Party
Buying
Priority
Rate
Service
Name
Title
Company
City/State/Zip
Telephone
Fax
Email Address
Preferred Method of Contact:
Phone
Fax
Email
(check preference)
Thank you for your consideration of our services.
If you experience difficulty in submitting this form, please complete and print the page and fax to: 1-866-308-3450 or (717) 285-2705. You may also call us at any time (1-888-737-3449).
