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Contact Information
First Name * Last Name *
eMail Address *
Confirm eMail Address *
Company Name *
Check here if your contact information is the same as your pickup information.
Phone Number * Example: 1 310 6043311 Please include your phone number so we may contact you with questions or updates related to your pickup request.
Country Code Area Code Phone Number
Pickup Information
First Name * Last Name *
City *
State / Province *
Zip / Postal Code *
Country *
Company Name *
Address * Address Line Two
Account Number Your Reference Number
Phone Number Example: 1 310 6043311 Please include your phone number so we may contact you with questions or updates related to your pickup request.
Country Code Area Code Phone Number
Shipment Information
Mode of Transport *
AIR
 OCEAN
TRUCK
If OCEAN LCL
FCL
If FCL, state which type 20Ft 40Ft
Other
Other
Description of Goods * (No personal effects)
Hazardous Materials * Yes No
Commodity Classification Number
Number of Shipments *
Total Pieces for all Shipments *
Total Weight * Kilos Lbs
Dimensions * Centimeters Inches None
Piece(s) Length Width Height
Destination
Destination City *
State / Province *
Zip / Postal Code *
Country *
 
Requested Pickup Date *
Example: 09 JAN 05
 
My shipment will be available for pickup by (local time)
Dock closes at  
 
Payment Terms * Prepaid Collect
Additional Instructions or Comments