| Contact
Information |
| Name: |
|
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| Company
Name: |
|
|
| Phone: |
|
|
| E-Mail
Address: |
|
|
Please
include your phone number so we may contact you with questions or
updates related to your pickup request.
|
| Pickup
Location |
|
|
| Contact
Name: |
|
|
| Company
Name: |
|
|
| Street
Address: |
|
|
| City: |
|
| State/Prov.: |
|
| Zip/Postal
Code: |
|
| Phone
Number: |
|
|
|
| Shipment
Information |
| Requested
Pickup Date: |
/ / |
|
| Number
of Shipments: |
|
|
| Total
Pieces for All Shipments: |
No. |
| Total
Weight: |
|
|
| Note:
The time for the pickup needs to be the time zone of the pickup
location. |
| My
Shipment Will Be Available For Pickup By: |
|
|
| Dock
Closes At: |
|
|
| |
| Additional
Information: |
|
|
|
All information relating to rate charges and invoicing instructions must
be printed on the Bill of Lading.
|
