Pickup

	Please provide all relevant information pertaining to the shipment.
	We are able to provide better service if you submit as much information as possible.
	The form requires a valid account code. Please contact us if you need assistance.

(RED = required)

Your Name		Account code
Your Company		Pick Up Date
Phone		Ready Time
Fax		Closing Time
E-mail		Weight
Pieces		Destination Zip
Dimensions
Commodity
Pick up from
Bill of Lading?
Service Type		Priority Type

Please select any of the following options that may apply:

Hazardous Material	lift-gate delivery	residential delivery
helper required	lift-gate pick up	residential pick up
inside delivery	notify B4 delivery	sorting required
inside pick up	other (see comment)	trade show

Declared Value $ Released Value/lb. $

Comments:

Shipper:		Consignee:
Contact		Contact
Company		Company
Address		Address
City		City
State		State
Zip Code		Zip Code
Phone		Phone
FAX		FAX
E-mail		E-mail

Note: Shipments are subject to the written contract in effect on the date of shipment. In the event a written contract does not exist, services performed hereunder shall be subject to the terms and conditions of the Uniform Domestic Straight Bill of Lading set forth in the applicable motor carrier classification and/or tariff (s). Shippers must certify that the above named materials are properly classified, described, packaged, marked, and are in proper condition for transportation according to the applicable regulations of the US Department of Transportation.

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