| Contact Information |
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Name:
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Phone:
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E-mail Address:
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Please include your phone number so we may contact you with questions or updates related to your pickup request.
Please send me an e-mail that my pickup transmission was received by the local service center.
Note: Additional e-mail addresses and comments can be entered 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: |
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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 time for the pickup needs to 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 NBR: |
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Liftgate?
(Please note: Same day requests based on equipment availability.)
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Yes
No
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| Payment Terms: |
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| Service Level: |
Standard LTL
Guaranteed std. transit by Noon
Guaranteed std. transit by 5:00 PM
Quote I.D.: |
| Pickup Notes: |
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(Please note: Sealed Divider™ requests may require 24-hour advance 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 new service, provided for a
nominal fee (U.S. Domestic shipments or shipments between U.S. and Canada or Canadian Domestic shipments), will:
- Provide you with an automatic e-mail that includes the PRO# of the shipment, once picked up. If we are unable to successfully make the pickup, the e-mail will supply the reason why it was not completed and the date that it has been rescheduled.
- Ensure the reference number you supplied with this pickup request will be shown 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 reflected on your invoice.)
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| 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)
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| If you selected "Please send me an e-mail that my pickup transmission was received by the local service center" - 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 area is required |
