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Company name *

Name *

Phone number *

Email *

Description of item(s)
(Ex: spools of copper wire; plywood; steel pipe, etc.)

How is it packaged

Dimensions (per unit) (LxWxH)

Weight (per unit)

Are items on pallets (size)?

Are items stackable?

Loading address:

Destination address:

Date of pick-up:

Date of delivery:

Container sizes (if known):

Frequency and or volume (will you be shipping on a regular basis)?

Hazardous?

MSDS:

U N #:

Goods need repacking?

Rates to end destinations? (FTL & LTL freight)

Special conditions/requirements:

*required