Schedule a pickup Pickup Origin Information Shipper Acct#: Shipper Name: Pickup Address: Pickup City: Prov: Postal Code: Shipper Email: Shipper Phone: Contact Name: Pickup Details Pickup Date: Ready @: HH MM AM PM Close @: HH MM AM PM Billing Terms: Prepaid Collect QUOTE#: Declared Value: Shipper#: PO#: Interline Partner: Exchange City: US Shipment Broker Name: Consignee Information Consignee Acct#: Consignee Name: Address: Delivery City: Prov: Postal Code: Freight Details Freight Description: Total Pieces: Total Weight: Lbs or Kgs Lbs Kgs LxWxH (in INCHES): Dangerous Goods Classification: Not Applicable Combustible Corrosive Explosives Gas - Flammable Gas - Non Toxic Gas - Toxic Liquid - Flammable Liquid - Toxic Miscellaneouus Organic Peroxides Oxidizers Radioactive Materials Solid - Flammable Solid - Toxic Water - Reactable Flat Deck Reqd Heat Reqd Reefer Reqd Mall Private Residence Power Tailgate If more than one item, fill in details (Optional) Pieces Pkg UN# Description Length Width Height TotalWeight Bundles Boxes Cartons Drums Pallets Pup Rolls Tires Truckload Bundles Boxes Cartons Drums Pallets Pup Rolls Tires Truckload Bundles Boxes Cartons Drums Pallets Pup Rolls Tires Truckload Bundles Boxes Cartons Drums Pallets Pup Rolls Tires Truckload Bundles Boxes Cartons Drums Pallets Pup Rolls Tires Truckload Bundles Boxes Cartons Drums Pallets Pup Rolls Tires Truckload Bundles Boxes Cartons Drums Pallets Pup Rolls Tires Truckload Bundles Boxes Cartons Drums Pallets Pup Rolls Tires Truckload Instructions: For DANGEROUS GOODS shipments: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, are properly classified and packaged, have DANGEROUS GOODS safety marks properly affixed or displayed on them, and are in all respects in proper condition for transport according to the Transportation of Goods Regulations. Agree to Terms and Conditions
