Street Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Person *

The person requesting this quote on behalf of the shipper.

First Name

Last Name

Phone *

The number of the Contact Person for the shipper.

(###)

###

####

Address of Receiver *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Consignee Contact *

Name of Contact Person Receiving the Shipment

First Name

Last Name

Consignee Phone *

(###)

###

####

Weight Unit of Measurement *

Lbs

Kgs

Type of Shipment *

Please check all that apply

Small Packages: Parts, Medical Supplies, Envelopes, Boxes

Grocery: Dry Goods, Frozen, Produce

Materials: Building, Electrical, Plumbing

Furniture: Living Room, Dining Room, Bedroom Suite, Mattress Sets

Recreational Equipment: Quad, Kids Quad, Side-by-Side, Snowmobile, Riding Lawn Tractor

Scooters, Electric Wheelchair, Manual Wheelchair

Other: Please specify in Other Comments.

Dangerous Goods: *

Yes

No

Temperature Control Required

Heat

Refrigeration

N/A

Trailer Load Types:

Full Trailer Load

3/4 Trailer Load

1/2 Trailer Load

1/4 Trailer Load

Freight Charges

PREPAID by Shipper

COLLECT to Consignee