| Contact Information |
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Name: |
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Phone: |
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x
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E-mail Address |
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Please include your phone number, so that we may contact you with questions or updates related to your pickup request.
Please send me an e-mail to inform me that my local service center received my pickup request.
Note: Please enter additional e-mail addresses and comments at the bottom of this form.
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Pickup Location |
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Contact Name: |
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| Company Name: |
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| Street Address: |
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| City: |
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| State/Prov., ZIP/Postal Code: |
,
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| Phone Number: |
( )
- x
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| Shipment Information |
| Requested Pickup Date: |
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| Number of Shipments: |
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| Total Pieces for All Shipments: |
No.
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| Total Weight: |
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Note: The pickup time must be the time zone of the pickup location.
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| My Shipment Will Be Available for Pickup By: |
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| Dock Closes at: |
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| Hazardous Materials?: |
Yes
No |
If Haz Mat,
Please Provide ID #: |
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Liftgate?:
(Note: Same-day requests based on equipment availability.) |
Yes
No |
| Payment Terms: |
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| Service Level: |
Standard LTL
Guaranteed std. transit by noon
Guaranteed std. transit by 5 p.m.
Quote I.D.
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| Pickup Notes: |
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(Note: Sealed Divider™ requests may require 24-hour notice.) |
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All information relating to rate charges and invoicing instructions must be printed on the bill of lading.
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| Certified Pickup (Optional)
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This service, provided for a
nominal fee (U.S. Domestic shipments or shipments between the United States and Canada or Canada Domestic shipments), will:
- Deliver an automatic e-mail that includes the PRO# of the shipment after we pick it up. If we can't complete the pickup, the e-mail will tell you why it was not completed and the date for which we have rescheduled it.
- Ensure the reference number you supplied with your pickup request will be on your invoice.
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I would like to certify this pickup request.
(By checking this box, you are accepting the charges for this service. Charges will be on your invoice.) |
| Certified Pickup E-mail Address: |
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| Customer Tracking ID Type, ID #: |
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Shipment Destination Information:
(Required only if Certified Pickup Service is requested) |
| Consignee Name: |
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| Consignee City: |
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| Consignee State/Prov., Country: |
,
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| Consignee ZIP/Postal Code: |
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Additional Confirmation E-mails (Optional) |
| If you selected "Please send me an e-mail to inform me that my local service center received my pickup request." and want a copy sent to additional addresses on your behalf, please complete the fields below. |
| Additional e-mail addresses: |
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Information in the shaded areas is required. |
